Provider Demographics
NPI:1154447068
Name:POLK COUNTY MENTAL HEALTH
Entity Type:Organization
Organization Name:POLK COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KRAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:503-623-9289
Mailing Address - Street 1:182 SW ACADEMY ST
Mailing Address - Street 2:SUITE # 304
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1922
Mailing Address - Country:US
Mailing Address - Phone:503-623-9289
Mailing Address - Fax:503-623-1874
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:SUITE # 304
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1922
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:503-623-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management