| Wallowa Valley Center For Wellness | |
|
606 Medical Pkwy Enterprise OR 97828-5140 | |
| (541) 426-4524 | |
| (541) 426-3035 |
| Full Name | Wallowa Valley Center For Wellness |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 606 Medical Pkwy, Enterprise, Oregon |
| Authorized Official Name and Position | Jim Nave (BOARD CHAIR) |
| Authorized Official Contact | 5414264524 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallowa Valley Center For Wellness Po Box 268 Enterprise OR 97828-0268 Ph: (541) 426-4524 | Wallowa Valley Center For Wellness 606 Medical Pkwy Enterprise OR 97828-5140 Ph: (541) 426-4524 |
| NPI Number | 1043249907 |
|---|---|
| Provider Enumeration Date | 07/02/2006 |
| Last Update Date | 11/03/2024 |
| Certification Date | 11/03/2024 |
| Medicare PECOS PAC ID | 0143228536 |
|---|---|
| Medicare Enrollment ID | O20061120000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043249907 | NPI | - | NPPES |
| Provider Name | Joshua F Boverman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619064664 PECOS PAC ID: 6901967116 Enrollment ID: I20081205000778 |
| Provider Name | Laurence Colman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225106032 PECOS PAC ID: 4183760663 Enrollment ID: I20091014000427 |
| Provider Name | Dolores I Beck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780040022 PECOS PAC ID: 4486958428 Enrollment ID: I20160211000650 |
| Provider Name | Sandra N Catlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669804837 PECOS PAC ID: 4789977463 Enrollment ID: I20160719001778 |
| Provider Name | Mollie E Cudmore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427499656 PECOS PAC ID: 0547541328 Enrollment ID: I20170110002616 |
| Provider Name | Jacqueline Marie Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720673577 PECOS PAC ID: 7113363391 Enrollment ID: I20240311001035 |
| Provider Name | Geunia Funches |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891233409 PECOS PAC ID: 7012451909 Enrollment ID: I20241014004652 |
| Provider Name | Brandon Scott Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144796178 PECOS PAC ID: 0143757997 Enrollment ID: I20241218002294 |
Wallowa Valley Center For Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 606 Medical Pkwy, Enterprise, OR 97828 Phone: 541-426-4524 |