Provider Demographics
NPI:1134374390
Name:MENTAL HEALTH ASSOCIATION OF BENTON COUNTY
Entity type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF BENTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLENAGHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:541-753-9219
Mailing Address - Street 1:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1054
Mailing Address - Country:US
Mailing Address - Phone:541-753-9219
Mailing Address - Fax:541-753-5368
Practice Address - Street 1:606 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4418
Practice Address - Country:US
Practice Address - Phone:541-753-9219
Practice Address - Fax:541-753-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR928320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness