Provider Demographics
NPI:1831492099
Name:AMMON, JOHN A (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:AMMON
Suffix:
Gender:M
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTRAL AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2272
Mailing Address - Country:US
Mailing Address - Phone:541-269-0321
Mailing Address - Fax:541-267-0785
Practice Address - Street 1:320 CENTRAL AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2272
Practice Address - Country:US
Practice Address - Phone:541-269-0321
Practice Address - Fax:541-267-0785
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional