Provider Demographics
NPI:1720743800
Name:LEMON, REBAL L
Entity Type:Individual
Prefix:
First Name:REBAL
Middle Name:L
Last Name:LEMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46083 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9213
Mailing Address - Country:US
Mailing Address - Phone:541-969-3901
Mailing Address - Fax:541-278-5419
Practice Address - Street 1:211 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2139
Practice Address - Country:US
Practice Address - Phone:541-278-6330
Practice Address - Fax:541-278-5419
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR34-2057513Medicaid