Raina Wickham, | |
1229 Main Street, Suite 105, Philomath, OR 97370 | |
(541) 609-1305 | |
(541) 714-3770 |
Full Name | Raina Wickham |
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Gender | Female |
Speciality | Counselor - Mental Health |
Location | 1229 Main Street, Suite 105, Philomath, Oregon |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1457686073 | NPI | - | NPPES |
500658765 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | 11-12-75 (Oregon) | Secondary |
101YM0800X | Counselor - Mental Health | MASTERS - PSU (Oregon) | Primary |
Entity Name | Philomath Counseling Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1255850889 PECOS PAC ID: 6507228392 Enrollment ID: O20230810001773 |
Mailing Address | Practice Location Address |
---|---|
Raina Wickham, 24971 Bluerock Ln, Corvallis, OR 97333-9554 Ph: (541) 609-1305 | Raina Wickham, 1229 Main Street, Suite 105, Philomath, OR 97370 Ph: (541) 609-1305 |
Megan Lynae Mccarthy, CADC II CRM II QMHA Counselor Medicare: Not Enrolled in Medicare Practice Location: 2004 College St, Philomath, OR 97370 Phone: 541-740-1650 | |
Mr. Vonnie Lee Lewis, LPC MENTAL HEALTH Counselor Medicare: Not Enrolled in Medicare Practice Location: 111 N 20th St, Philomath, OR 97370 Phone: 541-368-4313 Fax: 541-929-4967 | |
Lisa Burner, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1622 Main St, Philomath, OR 97370 Phone: 541-929-5683 | |
Elias Daniel Rademacher, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1229 Main St., #101, Philomath, OR 97370 Phone: 541-740-6589 Fax: 541-929-3052 | |
Rebecca D Anderson, LPC, CADC III Counselor Medicare: Not Enrolled in Medicare Practice Location: 1215 Main Street, Philomath, OR 97370 Phone: 503-871-9530 | |
Phoenix Ries, MS,LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1322 Main St., Philomath, OR 97370 Phone: 541-929-5065 |