Provider Demographics
NPI:1063375368
Name:ALTIERO, HOLLY JUNE (PHD, PCA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JUNE
Last Name:ALTIERO
Suffix:
Gender:F
Credentials:PHD, PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 NW MEDICAL LOOP STE ROSEBURG
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5597
Mailing Address - Country:US
Mailing Address - Phone:541-900-4285
Mailing Address - Fax:
Practice Address - Street 1:14764 SE WANDA DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267-3112
Practice Address - Country:US
Practice Address - Phone:971-266-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR12344101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty