Provider Demographics
NPI:1760768030
Name:VITOUSEK, TAOUEA J (LCSW)
Entity type:Individual
Prefix:
First Name:TAOUEA
Middle Name:J
Last Name:VITOUSEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14125 SW RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9370
Mailing Address - Country:US
Mailing Address - Phone:541-604-8431
Mailing Address - Fax:541-229-1213
Practice Address - Street 1:14125 SW RIDGE PL
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760-9370
Practice Address - Country:US
Practice Address - Phone:541-604-8431
Practice Address - Fax:541-229-1213
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL76871041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical