Provider Demographics
NPI:1316631914
Name:NEURODIVERGENT PEER SUPPORT LLC
Entity type:Organization
Organization Name:NEURODIVERGENT PEER SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-925-1653
Mailing Address - Street 1:1825 SE 50TH AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3235
Mailing Address - Country:US
Mailing Address - Phone:619-925-1637
Mailing Address - Fax:
Practice Address - Street 1:1825 SE 50TH AVE APT 107
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3235
Practice Address - Country:US
Practice Address - Phone:619-925-1637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty