Provider Demographics
NPI:1750319018
Name:VISTO, CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:VISTO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 DANIEL ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2033
Mailing Address - Country:US
Mailing Address - Phone:503-581-7454
Mailing Address - Fax:
Practice Address - Street 1:681 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3722
Practice Address - Country:US
Practice Address - Phone:503-588-5828
Practice Address - Fax:503-588-5852
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional