| NPI | 1700335536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY GONZALEZ Credentialing Manager 541-941-7792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR OR MD28195) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2023-03-07 |