Provider Demographics
NPI:1386941763
Name:JOYCE, MARY ESTHER (LPC, CADC I)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ESTHER
Last Name:JOYCE
Suffix:
Gender:F
Credentials:LPC, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SW 17TH PLACE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:503-690-0790
Mailing Address - Fax:855-474-7377
Practice Address - Street 1:2775 SW 17TH PLACE
Practice Address - Street 2:SUITE 3
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:503-690-0790
Practice Address - Fax:855-474-7377
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-19
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR1626101YM0800X
OROR2699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500637638Medicaid