| Gathered & Wise Llc | |
|
112 E Burnett St Stayton OR 97383-1704 | |
| (541) 704-7511 | |
| (541) 325-4082 |
| Full Name | Gathered & Wise Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 112 E Burnett St, Stayton, Oregon |
| Authorized Official Name and Position | Holly Elise Pomme (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 5417047511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gathered & Wise Llc 112 E Burnett St Stayton OR 97383-1704 Ph: (541) 704-7511 | Gathered & Wise Llc 112 E Burnett St Stayton OR 97383-1704 Ph: (541) 704-7511 |
| NPI Number | 1669830865 |
|---|---|
| Provider Enumeration Date | 02/02/2016 |
| Last Update Date | 12/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669830865 | NPI | - | NPPES |
| 500797440 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | L6179 (Oregon) | Primary |
Davenport Mental Health, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 615 N 1st Ave, Stayton, OR 97383 Phone: 503-877-4574 |