| NPI | 1689191165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN SHAW President 541-904-5216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical (Licence: OR L4658) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2024-06-21 |