| NPI | 1073060182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY WILLIAM HAYNES Program Coordinator 541-673-3504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 13-12-59) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |