Provider Demographics
NPI:1225882368
Name:PRELUDE
Entity Type:Organization
Organization Name:PRELUDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN-NAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:503-490-7076
Mailing Address - Street 1:230 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4692
Mailing Address - Country:US
Mailing Address - Phone:503-490-7076
Mailing Address - Fax:
Practice Address - Street 1:230 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4692
Practice Address - Country:US
Practice Address - Phone:503-490-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty