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General NPI Number Information
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NPI Number | 1710498001
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD TREATMENT CENTER
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 1485 MARKET ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3337
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Country | US
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Telephone | 541-653-8284
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Fax |
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Provider Business Mailing Address
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Address Line | 1485 MARKET ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3337
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Country | US
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Telephone | 541-653-8284
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MATTHEW OWEN
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Credential |
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Telephone | 541-653-8284
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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 | RO0507650
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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