Provider Demographics
NPI:1730309816
Name:WILLAMETTE VALLEY FAMILY CENTER
Entity Type:Organization
Organization Name:WILLAMETTE VALLEY FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-657-7235
Mailing Address - Street 1:610 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-657-7235
Mailing Address - Fax:503-657-7676
Practice Address - Street 1:610 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-657-7235
Practice Address - Fax:503-657-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103TC0700X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000WFBFMMedicare ID - Type UnspecifiedGROUP ID