Provider Demographics
NPI:1497109094
Name:MENDELSOHN, CHAVA
Entity Type:Individual
Prefix:
First Name:CHAVA
Middle Name:
Last Name:MENDELSOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 VERMONT ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3382
Mailing Address - Country:US
Mailing Address - Phone:541-217-6840
Mailing Address - Fax:
Practice Address - Street 1:281 LACLAIR ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2988
Practice Address - Country:US
Practice Address - Phone:541-266-6700
Practice Address - Fax:541-888-8726
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORTHW0947175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW0947OtherOREGON HEALTH AUTHORITY, TRADITIONAL HEALTH WORKER CERTIFICATION