| Lead | |
|
44 W Broadway Ste 225 Eugene OR 97401-3071 | |
| (971) 334-9295 | |
| Not Available |
| Full Name | Lead |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 44 W Broadway Ste 225, Eugene, Oregon |
| Authorized Official Name and Position | Tia Barnes (CHIEF PROGRAM OFFICER) |
| Authorized Official Contact | 5412556864 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lead Po Box 583 Eugene OR 97440-0583 Ph: (206) 295-9385 | Lead 44 W Broadway Ste 225 Eugene OR 97401-3071 Ph: (971) 334-9295 |
| NPI Number | 1205338365 |
|---|---|
| Provider Enumeration Date | 03/05/2018 |
| Last Update Date | 09/02/2020 |
| Certification Date | 08/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205338365 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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