Provider Demographics
NPI:1285328914
Name:BOYETTE, ESHE
Entity type:Individual
Prefix:
First Name:ESHE
Middle Name:
Last Name:BOYETTE
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:PO BOX 13355
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-1355
Mailing Address - Country:US
Mailing Address - Phone:503-208-5948
Mailing Address - Fax:
Practice Address - Street 1:7831 SE STARK ST STE 211
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2313
Practice Address - Country:US
Practice Address - Phone:503-208-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health