Provider Demographics
NPI:1700613064
Name:DEHART, SIBYLLE ARTEMISIA
Entity type:Individual
Prefix:
First Name:SIBYLLE
Middle Name:ARTEMISIA
Last Name:DEHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIBYLLE
Other - Middle Name:ARTEMISIA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 NW PARK AVE APT 419
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-4171
Mailing Address - Country:US
Mailing Address - Phone:571-533-4367
Mailing Address - Fax:
Practice Address - Street 1:714 MAIN ST STE B-207
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1826
Practice Address - Country:US
Practice Address - Phone:971-806-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health