Healthcare Provider Details

I. General information

NPI: 1902830524
Provider Name (Legal Business Name): KLAMATH CHILD AND FAMILY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 N ELDORADO AVE
KLAMATH FALLS OR
97601-6418
US

IV. Provider business mailing address

2210 N ELDORADO AVE
KLAMATH FALLS OR
97601-6418
US

V. Phone/Fax

Practice location:
  • Phone: 541-883-1030
  • Fax: 541-884-2338
Mailing address:
  • Phone: 541-883-1030
  • Fax: 541-884-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier223354
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. STANLEY DALE GILBERT
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC, LMFT
Phone: 541-883-1030