Provider Demographics
NPI:1013377357
Name:DYER, JOSEPH (QMHA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 NW 3RD ST APT A
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1229
Mailing Address - Country:US
Mailing Address - Phone:541-571-5743
Mailing Address - Fax:
Practice Address - Street 1:331 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2224
Practice Address - Country:US
Practice Address - Phone:541-276-6207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor