Healthcare Provider Details

I. General information

NPI: 1386767176
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF OREGON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST SUITE 100
GRESHAM OR
97030-4617
US

IV. Provider business mailing address

1080 MARINA VILLAGE PKWY SUITE 100
ALAMEDA CA
94501-6427
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-3808
  • Fax: 503-666-6835
Mailing address:
  • Phone: 503-666-6575
  • Fax: 503-666-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LESLIE DAVIS
Title or Position: SVP, CFO
Credential:
Phone: 510-337-7950