Provider Demographics
NPI:1215631510
Name:MONROE, STEVEN ANTONELLI (CADC II)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTONELLI
Last Name:MONROE
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 NE QUAIL XING
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3688
Mailing Address - Country:US
Mailing Address - Phone:154-122-6505
Mailing Address - Fax:
Practice Address - Street 1:1437 NE QUAIL XING
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3688
Practice Address - Country:US
Practice Address - Phone:154-122-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-04-20150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)