MEDICARE: MAXS MISSION

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

General Provider Information

NPI Number	:	1609739689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXS MISSION

Provider Business Mailing Address
First Line	:	3815 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4759
Country	:	US
Telephone Number	:	541-499-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4759
Country	:	US
Telephone Number	:	541-499-8012
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DAVID PINSKY
Credential	:
Telephone Number	:	541-840-9314

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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