| NPI | 1174392260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA ANDERSON Credentialing Specialist 541-322-7678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-12-29 |
| Last Update Date | 2024-06-05 |