Provider Demographics
NPI:1730317033
Name:CHILD & ADOLESCENT RESOURCE CENTER, LLC
Entity Type:Organization
Organization Name:CHILD & ADOLESCENT RESOURCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC I
Authorized Official - Phone:503-472-2233
Mailing Address - Street 1:1736 NE HEMBREE ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3314
Mailing Address - Country:US
Mailing Address - Phone:503-472-2233
Mailing Address - Fax:503-472-2299
Practice Address - Street 1:1736 NE HEMBREE ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3314
Practice Address - Country:US
Practice Address - Phone:503-472-2233
Practice Address - Fax:503-472-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-12-12101YA0400X
ORL44591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty