Provider Demographics
NPI:1437297140
Name:VALLEY VIEW MENTAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:VALLEY VIEW MENTAL HEALTH SERVICES, INC
Other - Org Name:VALLEY VIEW COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:K
Authorized Official - Last Name:ECKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-673-3985
Mailing Address - Street 1:1652 NW HUGHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8844
Mailing Address - Country:US
Mailing Address - Phone:541-673-3985
Mailing Address - Fax:541-673-8060
Practice Address - Street 1:1652 NW HUGHWOOD CT
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8844
Practice Address - Country:US
Practice Address - Phone:541-673-3985
Practice Address - Fax:541-673-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0681101YP2500X
ORC0724101YP2500X
ORC1119101YP2500X
ORC1120101YP2500X
OR710103TC0700X
ORL33131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR816113000OtherREGENCE BLUE CROSS BLUE S
OR500692711Medicaid
OR500692711Medicaid
ORR00WBBBBAMedicare PIN