Provider Demographics
NPI:1720456635
Name:LITTLE, JUSTIN GERALD BIXBY (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:GERALD BIXBY
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-3148
Mailing Address - Country:US
Mailing Address - Phone:360-553-2814
Mailing Address - Fax:
Practice Address - Street 1:704 W HOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1529
Practice Address - Country:US
Practice Address - Phone:541-640-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60817829106H00000X
ORT1903106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist