Provider Demographics
NPI:1578624300
Name:DISCOVERY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:DISCOVERY BEHAVIORAL HEALTH
Other - Org Name:DSICVOERY COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WINFIELD
Authorized Official - Last Name:CREW
Authorized Official - Suffix:III
Authorized Official - Credentials:CADCII, NCACII
Authorized Official - Phone:541-574-9050
Mailing Address - Street 1:111 SE DOUGLAS ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4499
Mailing Address - Country:US
Mailing Address - Phone:541-574-9050
Mailing Address - Fax:541-574-9052
Practice Address - Street 1:111 SE DOUGLAS ST
Practice Address - Street 2:SUITE E
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4499
Practice Address - Country:US
Practice Address - Phone:541-574-9050
Practice Address - Fax:541-574-9052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134929Medicaid