Provider Demographics
NPI:1265959563
Name:PIERCE, BETTINA TAMICE
Entity type:Individual
Prefix:
First Name:BETTINA
Middle Name:TAMICE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETTINA
Other - Middle Name:TAMICE
Other - Last Name:EHRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:627 NE EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3923
Mailing Address - Country:US
Mailing Address - Phone:503-435-1918
Mailing Address - Fax:503-472-9018
Practice Address - Street 1:627 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3923
Practice Address - Country:US
Practice Address - Phone:503-435-1918
Practice Address - Fax:503-472-9018
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORAW05559BMedicaid