Provider Demographics
NPI:1033383161
Name:AMAZING TREATMENT
Entity Type:Organization
Organization Name:AMAZING TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:503-930-6744
Mailing Address - Street 1:161 HIGH ST SE STE 225
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3621
Mailing Address - Country:US
Mailing Address - Phone:503-930-6744
Mailing Address - Fax:503-363-0833
Practice Address - Street 1:161 HIGH ST SE STE 225
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3621
Practice Address - Country:US
Practice Address - Phone:503-930-6744
Practice Address - Fax:503-363-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000329101YA0400X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty