Provider Demographics
NPI:1932330008
Name:OREGON MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:OREGON MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-835-5050
Mailing Address - Street 1:602 PLEASANT OAK DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3282
Mailing Address - Country:US
Mailing Address - Phone:608-835-5050
Mailing Address - Fax:
Practice Address - Street 1:602 PLEASANT OAK DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-3282
Practice Address - Country:US
Practice Address - Phone:608-835-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health