Provider Demographics
NPI:1174725154
Name:MALONE, CHIHARU TACHI IX (LPC)
Entity type:Individual
Prefix:MRS
First Name:CHIHARU
Middle Name:TACHI
Last Name:MALONE
Suffix:IX
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHIHARU
Other - Middle Name:TACHI
Other - Last Name:BLATT
Other - Suffix:IX
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4455 NE HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-758-5900
Mailing Address - Fax:
Practice Address - Street 1:4455 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-758-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-02
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ORC4263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500665675Medicaid