| Brightways Counseling Group At Woodburn Llc | |
|
1310 Meridian Dr Woodburn OR 97071-9668 | |
| (503) 953-0310 | |
| Not Available |
| Full Name | Brightways Counseling Group At Woodburn Llc |
|---|---|
| Speciality | Counselor |
| Location | 1310 Meridian Dr, Woodburn, Oregon |
| Authorized Official Name and Position | Joseph Zeimentz (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 3039094107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brightways Counseling Group At Woodburn Llc Po Box 3790 Bend OR 97707-0790 Ph: () - | Brightways Counseling Group At Woodburn Llc 1310 Meridian Dr Woodburn OR 97071-9668 Ph: (503) 953-0310 |
| NPI Number | 1457930760 |
|---|---|
| Provider Enumeration Date | 04/05/2021 |
| Last Update Date | 06/28/2021 |
| Certification Date | 06/28/2021 |
| Medicare PECOS PAC ID | 6103299284 |
|---|---|
| Medicare Enrollment ID | O20230310002561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457930760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lupita Pena-baltazar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104050947 PECOS PAC ID: 9335513431 Enrollment ID: I20230313000272 |
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