Provider Demographics
NPI:1740649821
Name:VAN DRIEL, ELIZABETH (QMHA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VAN DRIEL
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 IVERN DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-3621
Mailing Address - Country:US
Mailing Address - Phone:541-944-1391
Mailing Address - Fax:
Practice Address - Street 1:149 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535
Practice Address - Country:US
Practice Address - Phone:541-535-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health