Provider Demographics
NPI:1356930424
Name:CENTRAL OREGON FAMILY THERAPY
Entity type:Organization
Organization Name:CENTRAL OREGON FAMILY THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-233-9153
Mailing Address - Street 1:2622 SW GLACIER PL STE 120
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7866
Mailing Address - Country:US
Mailing Address - Phone:541-233-9153
Mailing Address - Fax:
Practice Address - Street 1:2622 SW GLACIER PL STE 120
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7866
Practice Address - Country:US
Practice Address - Phone:541-233-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)