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General NPI Number Information
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NPI Number | 1619772829
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Entity Type | Organization
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Legal Business Name | TRADITIONAL WAYS HEALING COLLECTIVE
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 412 MICHIGAN AVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-2624
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Country | US
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Telephone | 541-281-9330
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Fax | 541-205-6000
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Provider Business Mailing Address
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Address Line | PO BOX 1694
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-0095
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Country | US
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Telephone | 541-281-9330
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RENEE FRYE
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Credential | CRM, PSS, QMHA, CADC
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Telephone | 541-281-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State |
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