| Tahana Whitecrow Outpatient | |
|
2350 Wallace Rd Nw Salem OR 97304-2127 | |
| (503) 585-0564 | |
| (503) 585-3302 |
| Full Name | Tahana Whitecrow Outpatient |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2350 Wallace Rd Nw, Salem, Oregon |
| Authorized Official Name and Position | Melanie Mae Smith (DIRECTOR SUBSTANCE ABUSE COUNSELOR) |
| Authorized Official Contact | 5035850564 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tahana Whitecrow Outpatient 2350 Wallace Rd Nw Salem OR 97304-2127 Ph: (503) 585-0564 | Tahana Whitecrow Outpatient 2350 Wallace Rd Nw Salem OR 97304-2127 Ph: (503) 585-0564 |
| NPI Number | 1356322713 |
|---|---|
| Provider Enumeration Date | 11/10/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356322713 | NPI | - | NPPES |
| 132832 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (Oregon) | Primary |
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