| Willamette Valley Treatment Center, Inc. | |
|
115 Lancaster Dr Ne Salem OR 97301-5110 | |
| (503) 391-9762 | |
| (503) 315-2019 |
| Full Name | Willamette Valley Treatment Center, Inc. |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 115 Lancaster Dr Ne, Salem, Oregon |
| Authorized Official Name and Position | Jay M Lawshe (EXECUTIVE PROGRAM DIRECTOR/SPONSOR) |
| Authorized Official Contact | 5033919762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willamette Valley Treatment Center, Inc. 115 Lancaster Dr Ne Salem OR 97301-5110 Ph: (503) 391-9762 | Willamette Valley Treatment Center, Inc. 115 Lancaster Dr Ne Salem OR 97301-5110 Ph: (503) 391-9762 |
| NPI Number | 1205944204 |
|---|---|
| Provider Enumeration Date | 08/29/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205944204 | NPI | - | NPPES |
| 227068 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | OR10-036M (Oregon) | Primary |
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