Provider Demographics
NPI:1750741971
Name:STAHL, SIRENA
Entity type:Individual
Prefix:
First Name:SIRENA
Middle Name:
Last Name:STAHL
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 1:5176 NE WILLAMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ADAIR VILLAGE
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4543
Practice Address - Country:US
Practice Address - Phone:541-753-2230
Practice Address - Fax:541-758-8347
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor