Provider Demographics
NPI:1891594198
Name:SATTERSTROM, BEAR ANAYA
Entity type:Individual
Prefix:MR
First Name:BEAR
Middle Name:ANAYA
Last Name:SATTERSTROM
Suffix:
Gender:
Credentials:
Other - Prefix:MR
Other - First Name:MOON BEAR
Other - Middle Name:ANAYA
Other - Last Name:SATTERSTROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR MOON SATTERSTROM
Mailing Address - Street 1:65 STERLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9045
Mailing Address - Country:US
Mailing Address - Phone:541-450-3108
Mailing Address - Fax:
Practice Address - Street 1:65 STERLING CREEK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9045
Practice Address - Country:US
Practice Address - Phone:541-450-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health