Provider Demographics
NPI:1699092908
Name:MCCAFFERTY, LOREEN LOUISE (RC, CDP)
Entity type:Individual
Prefix:MS
First Name:LOREEN
Middle Name:LOUISE
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:RC, CDP
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 268
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-0268
Mailing Address - Country:US
Mailing Address - Phone:541-426-0813
Mailing Address - Fax:541-426-0802
Practice Address - Street 1:207 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1203
Practice Address - Country:US
Practice Address - Phone:541-426-0813
Practice Address - Fax:541-426-0802
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60126403101YA0400X
WARC00052055101YA0400X
OR14-R-09101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)