| Tetralemma Llc | |
|
302 Ne Plymouth Cir Corvallis OR 97330-4126 | |
| (541) 714-5123 | |
| Not Available |
| Full Name | Tetralemma Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 302 Ne Plymouth Cir, Corvallis, Oregon |
| Authorized Official Name and Position | Mark Davis (OWNER) |
| Authorized Official Contact | 5417145123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tetralemma Llc 302 Ne Plymouth Cir Corvallis OR 97330-4126 Ph: () - | Tetralemma Llc 302 Ne Plymouth Cir Corvallis OR 97330-4126 Ph: (541) 714-5123 |
| NPI Number | 1386262673 |
|---|---|
| Provider Enumeration Date | 07/13/2020 |
| Last Update Date | 01/08/2021 |
| Certification Date | 01/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386262673 | NPI | - | NPPES |
| 500783541 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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