| Stacy J Nielsen, Lcsw, Llc | |
|
11 Sw Brantley Dr Winston OR 97496-4526 | |
| (541) 679-0366 | |
| Not Available |
| Full Name | Stacy J Nielsen, Lcsw, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11 Sw Brantley Dr, Winston, Oregon |
| Authorized Official Name and Position | Stacy Jean Nielsen (OWNER) |
| Authorized Official Contact | 5418026597 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacy J Nielsen, Lcsw, Llc 11 Sw Brantley Dr Winston OR 97496 Ph: (541) 679-0366 | Stacy J Nielsen, Lcsw, Llc 11 Sw Brantley Dr Winston OR 97496-4526 Ph: (541) 679-0366 |
| NPI Number | 1861843310 |
|---|---|
| Provider Enumeration Date | 06/27/2016 |
| Last Update Date | 06/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861843310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | L6376 (Oregon) | Primary |
Riverside Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 671 S.w. Main, Winston, OR 97496 Phone: 541-679-6129 | |
Second Wind Mental Health Clinic Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 11 Sw Brantley Drive, Winston, OR 97496 Phone: 541-679-0366 Fax: 541-679-4821 |