1134374390 NPI number — MENTAL HEALTH ASSOCIATION OF BENTON COUNTY

Table of content: (NPI 1134374390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134374390 NPI number — MENTAL HEALTH ASSOCIATION OF BENTON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH ASSOCIATION OF BENTON COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134374390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97339-1054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-753-9219
Provider Business Mailing Address Fax Number:
541-753-5368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 SW 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97333-4418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-753-9219
Provider Business Practice Location Address Fax Number:
541-753-5368
Provider Enumeration Date:
12/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLENAGHAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
541-753-9219

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  928 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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