Healthcare Provider Details

I. General information

NPI: 1154619963
Provider Name (Legal Business Name): OSOA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SE 1ST ST
PENDLETON OR
97801-2204
US

IV. Provider business mailing address

PO BOX 1703 114 SE 1ST ST
PENDLETON OR
97801-0540
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-9000
  • Fax: 855-738-7698
Mailing address:
  • Phone: 541-429-9000
  • Fax: 855-738-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07-09-56
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number062120
License Number StateOR

VIII. Authorized Official

Name: MS. AMY ROSE ASHTON-WILLIAMS
Title or Position: A&D COUNSELOR, CLINICAL SOCIAL WORK
Credential: CADC II, LCSW
Phone: 541-429-9000