| NPI | 1629724695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN SHAW Member 541-647-3076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2022-03-18 |