| NPI | 1992339816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELYNDA OWENS Billing & Credentialing Manager 541-500-8655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-02-29 |
| Last Update Date | 2020-02-29 |