Healthcare Provider Details

I. General information

NPI: 1144299934
Provider Name (Legal Business Name): BENTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NW 27TH ST
CORVALLIS OR
97330-5223
US

IV. Provider business mailing address

530 NW 27TH ST
CORVALLIS OR
97330-5223
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-6637
  • Fax:
Mailing address:
  • Phone: 541-766-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3494
License Number StateOR

VIII. Authorized Official

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