Healthcare Provider Details

I. General information

NPI: 1467512335
Provider Name (Legal Business Name): BENTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 NW MONROE AVE
CORVALLIS OR
97330-4721
US

IV. Provider business mailing address

PO BOX 579
CORVALLIS OR
97339-0579
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-3540
  • Fax: 541-766-3543
Mailing address:
  • Phone: 541-766-3540
  • Fax: 541-766-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: LACEY MOLLEL
Title or Position: HEALTH CENTER DIRECTOR
Credential:
Phone: 541-766-6835