Provider Demographics
NPI:1225276157
Name:IMEL, JANICE D (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:D
Last Name:IMEL
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SW 3RD ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4692
Mailing Address - Country:US
Mailing Address - Phone:541-602-4580
Mailing Address - Fax:
Practice Address - Street 1:230 SW 3RD ST
Practice Address - Street 2:SUITE 308
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4692
Practice Address - Country:US
Practice Address - Phone:541-602-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORC2743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC2743OtherSTATE LICENSE
OR500653547Medicaid