Provider Demographics
NPI:1033652565
Name:TODOROVICH, NICK M
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:M
Last Name:TODOROVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4543
Mailing Address - Country:US
Mailing Address - Phone:541-753-2230
Mailing Address - Fax:541-758-8347
Practice Address - Street 1:306 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4543
Practice Address - Country:US
Practice Address - Phone:541-753-2230
Practice Address - Fax:541-758-8347
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)