Provider Demographics
NPI:1649500190
Name:HAPP, THERESA MAUREEN
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MAUREEN
Last Name:HAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:MAUREEN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1146 NE FREEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3213
Mailing Address - Country:US
Mailing Address - Phone:971-221-0783
Mailing Address - Fax:
Practice Address - Street 1:621 W MADRONE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3090
Practice Address - Country:US
Practice Address - Phone:541-440-3532
Practice Address - Fax:541-957-3790
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA2547OtherCERTIFICATE OF CLINICAL SOCIAL WORK ASSOCIATE