| Polk Yamhill & Marion Child Treatment Services Inc | |
|
965 Liberty St Se Salem OR 97302-4138 | |
| (503) 588-2004 | |
| (503) 588-2415 |
| Full Name | Polk Yamhill & Marion Child Treatment Services Inc |
|---|---|
| Speciality | Counselor |
| Location | 965 Liberty St Se, Salem, Oregon |
| Authorized Official Name and Position | Bette Jane M Cox (OFFICE MANAGER) |
| Authorized Official Contact | 5035882004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Polk Yamhill & Marion Child Treatment Services Inc 965 Liberty St Se Salem OR 97302-4138 Ph: (503) 588-2004 | Polk Yamhill & Marion Child Treatment Services Inc 965 Liberty St Se Salem OR 97302-4138 Ph: (503) 588-2004 |
| NPI Number | 1760685176 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 09/11/2025 |
| Medicare PECOS PAC ID | 1557357993 |
|---|---|
| Medicare Enrollment ID | O20040422000050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760685176 | NPI | - | NPPES |
| 042577 | Medicaid | OR |
| Provider Name | David T Dougher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750431441 PECOS PAC ID: 7517142730 Enrollment ID: I20110505000815 |
| Provider Name | Charlean Clemons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740310457 PECOS PAC ID: 4981866191 Enrollment ID: I20120504000556 |
| Provider Name | Dana Thompson Gamallo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083955629 PECOS PAC ID: 8527332543 Enrollment ID: I20170914001792 |
| Provider Name | Sarah C Henning |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609348333 PECOS PAC ID: 1557722014 Enrollment ID: I20230731002695 |
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