| NPI | 1447329529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELIA CLARK Credentialing Specialist 541-201-3973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2022-03-29 |