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General NPI Number Information
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NPI Number | 1144979063
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Entity Type | Organization
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Legal Business Name | ECLECTIC BEHAVIORAL HEALTH SOLUTIONS LLC
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 2075 KNOWLES RD
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City | MEDFORD
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State | OR
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Zip | 97501-9530
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Country | US
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Telephone | 541-944-8246
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | PHOENIX
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State | OR
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Zip | 97535-1770
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Country | US
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Telephone | 541-622-2727
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Fax | 541-512-2393
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MS. LYNN WILTROUT
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Credential |
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Telephone | 541-622-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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