| NPI | 1720105489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELIA CLARK Credentialing 541-201-3973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-08-10 |