MEDICARE: DISCOVERY BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578624300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVERY BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	111 SE DOUGLAS ST
Second Line	:	SUITE E
City	:	NEWPORT
State	:	OR
Zip	:	97365-4499
Country	:	US
Telephone Number	:	541-574-9050
Fax Number	:	541-574-9052

Provider Business Practice Location Address
First Line	:	111 SE DOUGLAS ST
Second Line	:	SUITE E
City	:	NEWPORT
State	:	OR
Zip	:	97365-4499
Country	:	US
Telephone Number	:	541-574-9050
Fax Number	:	541-574-9052

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES WINFIELD CREW III
Credential	:	CADCII, NCACII
Telephone Number	:	541-574-9050

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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Directions to “DISCOVERY BEHAVIORAL HEALTH ” Practice Location

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