=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508940370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OREGON MENTAL HEALTH SVS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 602 PLEASANT OAK DR
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-835-5050
-----------------------------------------------------
Fax | 608-835-5050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 602 PLEASANT OAK DR
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-835-5050
-----------------------------------------------------
Fax | 608-835-5050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER/CLINIC OWNER
-----------------------------------------------------
Name | MARY JOAN SELLA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 608-835-5050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------