| NPI | 1285815142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH ROBERT MAIER Sec Tres 541-322-8830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR PA00354) |
| 208D00000X General Practice (Licence: OR MD07348) | |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2018-01-11 |