Healthcare Provider Details

I. General information

NPI: 1164229761
Provider Name (Legal Business Name): TRADITIONAL WAYS HEALING COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MICHIGAN AVE
KLAMATH FALLS OR
97601-2624
US

IV. Provider business mailing address

PO BOX 1694
KLAMATH FALLS OR
97601-0095
US

V. Phone/Fax

Practice location:
  • Phone: 541-281-9330
  • Fax: 541-205-6000
Mailing address:
  • Phone: 541-281-9330
  • Fax: 541-205-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENEE FRYE
Title or Position: AUTHORIZED AGENT
Credential: CRM, PSS, QMHA, CADC
Phone: 541-281-9330