| NPI | 1720612963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA S FULLER Owner 541-579-8644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2024-03-28 |