Provider Demographics
NPI:1255495289
Name:BRAATEN, MARJORIE MAXINE (QMHP)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:MAXINE
Last Name:BRAATEN
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 COURT ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4239
Mailing Address - Country:US
Mailing Address - Phone:503-566-6580
Mailing Address - Fax:503-585-4908
Practice Address - Street 1:3180 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4532
Practice Address - Country:US
Practice Address - Phone:503-588-5351
Practice Address - Fax:503-585-4908
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health