Provider Demographics
NPI:1033672613
Name:MEESE, GABRIELLE M (CADC-R)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:M
Last Name:MEESE
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:M
Other - Last Name:MEESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC-R
Mailing Address - Street 1:125 SW C ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1458
Mailing Address - Country:US
Mailing Address - Phone:541-306-4566
Mailing Address - Fax:541-320-9005
Practice Address - Street 1:125 SW C ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1458
Practice Address - Country:US
Practice Address - Phone:541-306-4566
Practice Address - Fax:541-320-9005
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR82-1905562101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT-19-184OtherMHACCBO