Provider Demographics
NPI:1114498854
Name:WESTERN CLINICAL & FORENSIC SERVICES
Entity Type:Organization
Organization Name:WESTERN CLINICAL & FORENSIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING / CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-562-4484
Mailing Address - Street 1:1400 EXECUTIVE PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7121
Mailing Address - Country:US
Mailing Address - Phone:541-802-6597
Mailing Address - Fax:
Practice Address - Street 1:1400 EXECUTIVE PKWY STE 260
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7121
Practice Address - Country:US
Practice Address - Phone:541-802-6597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902095334OtherINDIVIDUAL NPI