Provider Demographics
NPI:1134570948
Name:MEDRANO, JULIE (CADCII,NCGCII,CGACII)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:CADCII,NCGCII,CGACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SE 1ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2204
Mailing Address - Country:US
Mailing Address - Phone:541-429-9000
Mailing Address - Fax:
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862-1342
Practice Address - Country:US
Practice Address - Phone:541-861-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORG 00-00-12101Y00000X
OR835101Y00000X
OR97-04-52101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor