Provider Demographics
NPI:1316650443
Name:NONNARATH, ATSACHANH
Entity type:Individual
Prefix:MS
First Name:ATSACHANH
Middle Name:
Last Name:NONNARATH
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 1:1336 NW FLANDERS ST # 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2645
Mailing Address - Country:US
Mailing Address - Phone:409-245-9777
Mailing Address - Fax:
Practice Address - Street 1:19302 SW MARSHMALLOW PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-5010
Practice Address - Country:US
Practice Address - Phone:409-245-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2024-11-21
Deactivation Date:2023-05-16
Deactivation Code:
Reactivation Date:2023-08-31
Provider Licenses
StateLicense IDTaxonomies
ORR8518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health