Provider Demographics
NPI:1164754073
Name:VANTASSEL, MERCEDES ISOBEL (BS, QMHA, CADC II)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:ISOBEL
Last Name:VANTASSEL
Suffix:
Gender:F
Credentials:BS, QMHA, CADC II
Other - Prefix:
Other - First Name:ISOBEL
Other - Middle Name:
Other - Last Name:VANTASSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 160
Mailing Address - Street 2:46314 TIMINE WAY
Mailing Address - City:PENDELTON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:541-240-8754
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDELTON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-240-8754
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health