Individual
DESIREE MARIE-WILSON MACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
QMHPVARIANCE
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6775055
ODL
OR
Enumeration date
04/18/2023
Last updated
07/13/2023
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