Healthcare Provider Details

I. General information

NPI: 1487395471
Provider Name (Legal Business Name): BEHAVIOR AND MENTAL HEALTH CONSULTATION OF OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 SW FOREST AVE STE 102
REDMOND OR
97756-2762
US

IV. Provider business mailing address

PO BOX 712
REDMOND OR
97756-0144
US

V. Phone/Fax

Practice location:
  • Phone: 541-324-0873
  • Fax:
Mailing address:
  • Phone: 541-324-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MELISSA VALADEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 541-324-0873