Individual
MS. MICHELE TANTRIELLA-MODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
66 CLUB RD STE 160, EUGENE, OR 97401-2439
(541) 345-1722
(541) 485-7049
Mailing address
PO BOX 70779, SPRINGFIELD, OR 97475-0137
(541) 345-1722
(541) 485-7049
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C1796
OR
101YP2500X
Professional Counselor
Primary
C1796
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14652890
CAQH ID
—
05
—
500641977
—
OR
Enumeration date
10/17/2011
Last updated
11/14/2023
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