Provider Demographics
NPI:1407039308
Name:MID VALLEY COUNSELING CENTER INC
Entity Type:Organization
Organization Name:MID VALLEY COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER OF MVCC
Authorized Official - Prefix:MR
Authorized Official - First Name:GAILEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-364-6093
Mailing Address - Street 1:2250 D ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2768
Mailing Address - Country:US
Mailing Address - Phone:503-364-6093
Mailing Address - Fax:503-364-5121
Practice Address - Street 1:2250 D ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2768
Practice Address - Country:US
Practice Address - Phone:503-364-6093
Practice Address - Fax:503-364-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCBBBMedicare PIN