| NPI | 1326414087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESA WAGNER Credentialing Specialist 541-265-0445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2024-07-12 |