| NPI | 1083240386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY KATE COPPEDGE Owner 541-222-9231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2020-03-18 |