Provider Demographics
NPI:1952937575
Name:MCCARTY-MONK, ALLIE LIEN
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:LIEN
Last Name:MCCARTY-MONK
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 1:5024 BRIARWOOD CIR N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7532
Mailing Address - Country:US
Mailing Address - Phone:503-560-4022
Mailing Address - Fax:
Practice Address - Street 1:3494 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4607
Practice Address - Country:US
Practice Address - Phone:503-560-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician