Healthcare Provider Details

I. General information

NPI: 1093412579
Provider Name (Legal Business Name): BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 WESTWOOD DR NW
SALEM OR
97304-3749
US

IV. Provider business mailing address

1230 WESTWOOD DR NW
SALEM OR
97304-3749
US

V. Phone/Fax

Practice location:
  • Phone: 971-208-4663
  • Fax:
Mailing address:
  • Phone: 971-208-4663
  • Fax:

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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STACY BURDICK
Title or Position: CEO
Credential: DMIN. BCC RBAI
Phone: 971-208-4663