Provider Demographics
NPI:1326151788
Name:VILAS, NATASHA ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANNE
Last Name:VILAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 FOX ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9314
Mailing Address - Country:US
Mailing Address - Phone:541-292-9566
Mailing Address - Fax:541-292-5015
Practice Address - Street 1:861 FOX ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9314
Practice Address - Country:US
Practice Address - Phone:541-292-9566
Practice Address - Fax:541-292-5015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-PSY-APP-4445103TC0700X
OR1414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49700903Medicaid
HI49700903Medicaid