Provider Demographics
NPI:1881338556
Name:WILLAMETTE SKY COUNSELING
Entity type:Organization
Organization Name:WILLAMETTE SKY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELAINE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:WINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-643-2947
Mailing Address - Street 1:1400 HIGH STREET, STE B2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-600-2034
Mailing Address - Fax:541-780-6813
Practice Address - Street 1:1400 HIGH STREET, STE B2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-600-2034
Practice Address - Fax:541-780-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500803936Medicaid