Provider Demographics
NPI:1154928422
Name:THEODORE, MOLLY MARIE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:THEODORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MARIE
Other - Last Name:PAETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-0579
Mailing Address - Country:US
Mailing Address - Phone:541-766-6185
Mailing Address - Fax:541-766-6164
Practice Address - Street 1:4185 SW RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1783
Practice Address - Country:US
Practice Address - Phone:541-766-6767
Practice Address - Fax:541-766-6164
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator