MEDICARE: KLAMATH BEHAVORIAL HEALTH AND WELLNESS

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	101YM0800X	Mental Health Counselor		OR
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		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	:	1659355865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLAMATH BEHAVORIAL HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	3314 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3730
Country	:	US
Telephone Number	:	541-882-7291
Fax Number	:	541-883-4213

Provider Business Practice Location Address
First Line	:	3314 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3730
Country	:	US
Telephone Number	:	541-882-7291
Fax Number	:	541-883-4213

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. AMANDA BUNGER
Credential	:	MED
Telephone Number	:	541-882-7291

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	02/15/2013

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