| South Lane Mental Health Services, Inc | |
|
1345 Birch Ave Cottage Grove OR 97424-1416 | |
| (541) 942-3939 | |
| (541) 942-9310 |
| Full Name | South Lane Mental Health Services, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1345 Birch Ave, Cottage Grove, Oregon |
| Authorized Official Name and Position | Andrew Lee Yoder (ASSISTANT EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5419423939 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Lane Mental Health Services, Inc Po Box 5 Cottage Grove OR 97424-0001 Ph: (541) 942-3939 | South Lane Mental Health Services, Inc 1345 Birch Ave Cottage Grove OR 97424-1416 Ph: (541) 942-3939 |
| NPI Number | 1306905831 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 10/22/2024 |
| Certification Date | 10/22/2024 |
| Medicare PECOS PAC ID | 0042544504 |
|---|---|
| Medicare Enrollment ID | O20190703000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306905831 | NPI | - | NPPES |
| 019047 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sheryl A Hedges |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427065234 PECOS PAC ID: 6103883152 Enrollment ID: I20041213000019 |
| Provider Name | Becca D Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245430198 PECOS PAC ID: 7719073220 Enrollment ID: I20071015000269 |
| Provider Name | Jeff P Koeppel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235298696 PECOS PAC ID: 8426383910 Enrollment ID: I20190703002020 |
| Provider Name | Jessica Marie Yeager |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326458753 PECOS PAC ID: 9133407182 Enrollment ID: I20190709000603 |
| Provider Name | Kerstin Britz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598819484 PECOS PAC ID: 9830424142 Enrollment ID: I20190709001979 |
| Provider Name | Andrea M Hopkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699144840 PECOS PAC ID: 3678902673 Enrollment ID: I20200326000727 |
| Provider Name | Nicole L Baschleben |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235434200 PECOS PAC ID: 4284094053 Enrollment ID: I20230712003431 |
| Provider Name | Shemecia Forthner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457806465 PECOS PAC ID: 6709174469 Enrollment ID: I20230826000040 |
| Provider Name | Cyndi A. Tromba |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790066504 PECOS PAC ID: 2769825876 Enrollment ID: I20240206001887 |
| Provider Name | Chelsie Hugo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316359698 PECOS PAC ID: 3779006671 Enrollment ID: I20250401002824 |
| Provider Name | Heidi Baer-postigo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619649597 PECOS PAC ID: 5092238998 Enrollment ID: I20250401002986 |
| Provider Name | Trevor Whitbread |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1902421530 PECOS PAC ID: 6709309610 Enrollment ID: I20250401003101 |
| Provider Name | Rebecca Fitkin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518496496 PECOS PAC ID: 2466975214 Enrollment ID: I20250402000949 |
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