Provider Demographics
NPI:1740783190
Name:COUNCIL, MONIQUE (LMT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:COUNCIL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2214
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-2214
Mailing Address - Country:US
Mailing Address - Phone:971-710-9710
Mailing Address - Fax:
Practice Address - Street 1:311 SW 2ND ST # 2214
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4631
Practice Address - Country:US
Practice Address - Phone:971-710-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22198225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist