Healthcare Provider Details

I. General information

NPI: 1801925433
Provider Name (Legal Business Name): OREGON MENTAL HEALTH SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W NETHERWOOD ST STE A
OREGON WI
53575-1107
US

IV. Provider business mailing address

165 W NETHERWOOD ST STE A
OREGON WI
53575-1107
US

V. Phone/Fax

Practice location:
  • Phone: 608-835-5050
  • Fax: 608-835-5010
Mailing address:
  • Phone: 608-835-5050
  • Fax: 608-835-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2513
License Number StateWI

VIII. Authorized Official

Name: MRS. MARY J SELLA
Title or Position: CLINIC OWNER
Credential: LCSW
Phone: 608-835-5050