Provider Demographics
NPI:1760073639
Name:ALICIA VIANI THERAPY
Entity Type:Organization
Organization Name:ALICIA VIANI THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-301-6146
Mailing Address - Street 1:400 SW BLUFF DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1697
Mailing Address - Country:US
Mailing Address - Phone:541-301-6146
Mailing Address - Fax:
Practice Address - Street 1:400 SW BLUFF DR STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1697
Practice Address - Country:US
Practice Address - Phone:541-301-6146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1609016690OtherNPI
OR500638613Medicaid