Provider Demographics
NPI:1982230306
Name:MIDOREGON MENTAL HEALTH
Entity Type:Organization
Organization Name:MIDOREGON MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:M ADMIN
Authorized Official - Phone:541-460-5194
Mailing Address - Street 1:131 NW HAWTHORNE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2958
Mailing Address - Country:US
Mailing Address - Phone:541-460-5194
Mailing Address - Fax:541-647-1331
Practice Address - Street 1:131 NW HAWTHORNE AVE STE 207
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2958
Practice Address - Country:US
Practice Address - Phone:541-460-5194
Practice Address - Fax:541-647-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty