Healthcare Provider Details

I. General information

NPI: 1104152214
Provider Name (Legal Business Name): NEWAYS INTEGRATED WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 E MAIN ST SUITE 1
ASHLAND OR
97520
US

IV. Provider business mailing address

PO BOX 503010
WHITE CITY OR
97503-0813
US

V. Phone/Fax

Practice location:
  • Phone: 541-973-9673
  • Fax: 888-763-5973
Mailing address:
  • Phone: 541-941-7792
  • Fax: 503-419-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1762
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTIN CATHERINE MARY
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: LPC
Phone: 541-941-9246