Provider Demographics
NPI:1851531834
Name:MEZA, JO M (CAPC II NCAC)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:M
Last Name:MEZA
Suffix:
Gender:F
Credentials:CAPC II NCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HIGH ST SE STE 223
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3621
Mailing Address - Country:US
Mailing Address - Phone:503-930-6744
Mailing Address - Fax:503-363-0833
Practice Address - Street 1:161 HIGH ST SE STE 223
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3621
Practice Address - Country:US
Practice Address - Phone:503-930-6744
Practice Address - Fax:503-363-0833
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000329101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)