| NPI | 1033613815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS ERIC SUNDSTROM Owner/Provider 541-647-7820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: OR 4413) |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: OR 4413) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2018-10-05 |