Provider Demographics
NPI:1467926634
Name:DECELLES, NAOMI SUZANNE (AA)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:SUZANNE
Last Name:DECELLES
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:SUZANNE
Other - Last Name:STRAWSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:687 CHESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5060
Mailing Address - Country:US
Mailing Address - Phone:541-684-4100
Mailing Address - Fax:541-684-4156
Practice Address - Street 1:1651 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3363
Practice Address - Country:US
Practice Address - Phone:541-762-4525
Practice Address - Fax:541-684-4156
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7153221101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)