Provider Demographics
NPI:1528214459
Name:ROTHENBURGER, MARIA THERESA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:THERESA
Last Name:ROTHENBURGER
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:THERESA
Other - Last Name:ANTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5311
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0311
Mailing Address - Country:US
Mailing Address - Phone:971-301-4906
Mailing Address - Fax:503-877-1926
Practice Address - Street 1:161 HIGH ST SE STE 230
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:971-301-4906
Practice Address - Fax:503-877-1926
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH607047750101YM0800X
NJ37PC00392700101YP2500X
ORC4185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health