| NPI | 1538665013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JOSH LYDON Owner/Operator 541-900-4285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L7631) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2020-09-22 |