Healthcare Provider Details

I. General information

NPI: 1225418312
Provider Name (Legal Business Name): THE OASIS CENTER FOR COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 RIVER RD N
KEIZER OR
97303-4645
US

IV. Provider business mailing address

4575 RIVER RD N
KEIZER OR
97303-4645
US

V. Phone/Fax

Practice location:
  • Phone: 503-931-7245
  • Fax:
Mailing address:
  • Phone: 503-931-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC2943
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ROBYN LYNN TRAVIS
Title or Position: MANAGER/CLINICAL DIRECTOR
Credential: LPC
Phone: 503-931-7245