Provider Demographics
NPI:1265778039
Name:STRANGE, GENEVIEVE ROOTH (PSYD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:ROOTH
Last Name:STRANGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W ELLENDALE AVE STE 103-322
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1456
Mailing Address - Country:US
Mailing Address - Phone:971-915-0195
Mailing Address - Fax:
Practice Address - Street 1:2659 COMMERCIAL ST SE STE 216
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4496
Practice Address - Country:US
Practice Address - Phone:971-915-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02-11-53101YA0400X
OR2209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)