Provider Demographics
NPI:1356819536
Name:KOKKORIS, RITA (PLC)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:
Last Name:KOKKORIS
Suffix:
Gender:F
Credentials:PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 NW 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6462
Mailing Address - Country:US
Mailing Address - Phone:541-757-1761
Mailing Address - Fax:
Practice Address - Street 1:685 NW 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6462
Practice Address - Country:US
Practice Address - Phone:541-757-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5027101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR14363786OtherCAQH
ORC5027OtherOREGON BOARD OF LICENSING