| NPI | 1073147716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL FICKES Owner 541-324-7171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 1041C0700X Social Worker, Clinical | |
| 207Q00000X Family Medicine | |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2021-05-05 |