| Second Wind Mental Health Clinic | |
|
11 Sw Brantley Drive Winston OR 97496 | |
| (541) 679-0366 | |
| (541) 679-4821 |
| Full Name | Second Wind Mental Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 11 Sw Brantley Drive, Winston, Oregon |
| Authorized Official Name and Position | Tamara Lee (SINGLE MEMBER LLC) |
| Authorized Official Contact | 5416790366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Second Wind Mental Health Clinic 11 Sw Brantley Drive Winston OR 97496 Ph: (541) 679-0366 | Second Wind Mental Health Clinic 11 Sw Brantley Drive Winston OR 97496 Ph: (541) 679-0366 |
| NPI Number | 1679957708 |
|---|---|
| Provider Enumeration Date | 07/18/2015 |
| Last Update Date | 11/13/2015 |
| Medicare PECOS PAC ID | 2769792183 |
|---|---|
| Medicare Enrollment ID | O20151113001380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679957708 | NPI | - | NPPES |
| 363LP0808X | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 200550033NP (Oregon) | Primary |
| Provider Name | Tamara R Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992720965 PECOS PAC ID: 5698704914 Enrollment ID: I20050808000449 |
| Provider Name | Andrea Witham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275982324 PECOS PAC ID: 5799067674 Enrollment ID: I20171228000352 |
| Provider Name | Lisa Jennings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881052876 PECOS PAC ID: 5597026351 Enrollment ID: I20180219002682 |
| Provider Name | Jenny V Tausch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023649605 PECOS PAC ID: 6608297619 Enrollment ID: I20200529001985 |
| Provider Name | Michael Wayne Smith-fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154788065 PECOS PAC ID: 9638583669 Enrollment ID: I20210202001679 |
Adolescent Day Treatment Center Inc Of Douglas County Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 671 S.w. Main, Winston, OR 97496 Phone: 541-679-6129 | |
Stacy J Nielsen, Lcsw, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11 Sw Brantley Dr, Winston, OR 97496 Phone: 541-679-0366 |