| NPI | 1992243992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAINA MICHELLE TAGUE Er Diversion Specialist 541-513-4998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: OR M6979) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |