Provider Demographics
NPI:1023492055
Name:DEVORE, STEVEN JOEL
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOEL
Last Name:DEVORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97824-8757
Mailing Address - Country:US
Mailing Address - Phone:541-910-8216
Mailing Address - Fax:541-568-4030
Practice Address - Street 1:1201 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:COVE
Practice Address - State:OR
Practice Address - Zip Code:97824-8757
Practice Address - Country:US
Practice Address - Phone:541-910-8216
Practice Address - Fax:541-568-4030
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR525180320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness