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General NPI Number Information
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NPI Number | 1295038081
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 2225 PACIFIC BLVD SE SUITE 207
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City | ALBANY
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State | OR
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Zip | 97321-7907
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Country | US
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Telephone | 541-704-0762
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Fax | 541-704-0070
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Provider Business Mailing Address
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Address Line | 2225 PACIFIC BLVD SE SUITE 207
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City | ALBANY
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State | OR
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Zip | 97321-7907
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Country | US
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Telephone | 541-704-0762
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Fax | 541-704-0070
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Authorized Official
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Title or Position | OWNER/PRIMARY THERAPIST
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Name | JAY VANDENBOGAARD
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Credential |
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Telephone | 541-704-0762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 064
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 064
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License Number State | OR
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