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>> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1245424951

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
4455 NE HIGHWAY 20  CORVALLIS, OR 97330-9695 US
Tel: 541-758-5909  Fax: --

Contact information for business:
4455 NE HIGHWAY 20  CORVALLIS, OR 97330-9695 US
Tel: 541-758-5909  Fax: --

Registration Information:
NPI: 1245424951
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y104100000XBehavioral Health & Social Service Providers
Social Worker

Legacy codes, insurance codes and state license numbers:



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