Provider Demographics
NPI:1225805443
Name:STORY, MARIAH B (CADC I)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:B
Last Name:STORY
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:ATHENA
Mailing Address - State:OR
Mailing Address - Zip Code:97813-0324
Mailing Address - Country:US
Mailing Address - Phone:541-377-0003
Mailing Address - Fax:
Practice Address - Street 1:110 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1869
Practice Address - Country:US
Practice Address - Phone:541-429-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8352211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)