| NPI | 1407493513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RAMIREZ Billing & Credentialing Manager 541-500-8655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-12-08 |
| Last Update Date | 2019-12-08 |