Healthcare Provider Details

I. General information

NPI: 1598524084
Provider Name (Legal Business Name): SERENITY MENTAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 TANDY TURN
EUGENE OR
97401-5193
US

IV. Provider business mailing address

2837 TANDY TURN
EUGENE OR
97401-5193
US

V. Phone/Fax

Practice location:
  • Phone: 458-245-6948
  • Fax:
Mailing address:
  • Phone: 458-245-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CHARLES RANDALL ALLEN
Title or Position: OWNER
Credential: LCSW
Phone: 458-245-6948