| NPI | 1093249542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY KENYON Manager 541-255-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2023-06-05 |