Provider Demographics
NPI:1588835631
Name:WINWOOD CENTER FOR WELLNESS, LLC
Entity Type:Organization
Organization Name:WINWOOD CENTER FOR WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:CHIN-TEH
Authorized Official - Last Name:JU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-365-0045
Mailing Address - Street 1:780 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3462
Mailing Address - Country:US
Mailing Address - Phone:503-365-0045
Mailing Address - Fax:503-365-9590
Practice Address - Street 1:780 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 304
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3462
Practice Address - Country:US
Practice Address - Phone:503-365-0045
Practice Address - Fax:503-365-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1598103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278934OtherDMAP