Provider Demographics
NPI:1942407010
Name:KONOPASEK, JAMES E (MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:KONOPASEK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WASHINGTON ST
Mailing Address - Street 2:SUITE 206B
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2270
Mailing Address - Country:US
Mailing Address - Phone:541-490-7673
Mailing Address - Fax:541-298-5653
Practice Address - Street 1:502 WASHINGTON ST
Practice Address - Street 2:SUITE 206B
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2270
Practice Address - Country:US
Practice Address - Phone:541-490-7673
Practice Address - Fax:541-298-5653
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFC00000109101Y00000X
ORPOLYG EXAMINER - 173171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298043OtherOMAP PROVIDER NUMBER
ORL43392OtherDHS PROVIDER NUMBER
WA215538OtherWA DSHS PROVIDER NUMBER