Provider Demographics
NPI:1063085033
Name:MCALISTER, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MCALISTER
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 1:260 SW MADISON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4725
Mailing Address - Country:US
Mailing Address - Phone:503-877-2256
Mailing Address - Fax:
Practice Address - Street 1:260 SW MADISON AVE STE 105
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4725
Practice Address - Country:US
Practice Address - Phone:541-405-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7155101YM0800X
ORR7122101YM0800X
101YM0800X
ORC7664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health