Provider Demographics
NPI:1528199338
Name:LUTHERAN COMMUNITY SERVICES NW
Entity Type:Organization
Organization Name:LUTHERAN COMMUNITY SERVICES NW
Other - Org Name:LAKE COUNTY MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-883-3471
Mailing Address - Street 1:526 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1518
Mailing Address - Country:US
Mailing Address - Phone:541-947-6021
Mailing Address - Fax:541-947-6020
Practice Address - Street 1:526 CENTER ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1518
Practice Address - Country:US
Practice Address - Phone:541-947-6021
Practice Address - Fax:541-947-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123195Medicaid
OR193896Medicaid
OR123195Medicare UPIN
OR193896Medicaid