Provider Demographics
NPI:1659633501
Name:MICHELETTO, MISTI R (BED)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:R
Last Name:MICHELETTO
Suffix:
Gender:F
Credentials:BED
Other - Prefix:
Other - First Name:MISTI
Other - Middle Name:R
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BED
Mailing Address - Street 1:414 W OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2716
Mailing Address - Country:US
Mailing Address - Phone:541-579-3792
Mailing Address - Fax:
Practice Address - Street 1:260 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3247
Practice Address - Country:US
Practice Address - Phone:541-484-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health