Provider Demographics
NPI:1295038081
Name:CENTER FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CENTER FOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRIMARY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBOGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-704-0762
Mailing Address - Street 1:2225 PACIFIC BLVD SE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-7907
Mailing Address - Country:US
Mailing Address - Phone:541-704-0762
Mailing Address - Fax:541-704-0070
Practice Address - Street 1:2225 PACIFIC BLVD SE
Practice Address - Street 2:SUITE 207
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-7907
Practice Address - Country:US
Practice Address - Phone:541-704-0762
Practice Address - Fax:541-704-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR064251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500625423Medicaid