SOUTH LANE MENTAL HEALTH SERVICES, INC (NPI# 1245757772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245757772 |
| Entity Type | Organization |
| Organization Name | SOUTH LANE MENTAL HEALTH SERVICES, INC |
| Practice Address |
1345 Birch Ave Cottage Grove OR 97424-1416 |
| Practice Telephone | (541) 942-3939 |
| Practice Fax Number | 5419429310 |
| Mailing Telephone | 5419423939 |
| Mailing Fax Number | 5419429310 |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |
| Authorized Official Name | MS. THERESE NADINE MASTIN (QUALITY MANAGEMENT DIRECTOR) |
| Authorized Official Telephone | 5417674176 |
| Authorized Official Credential | MA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
102491-83 | OR | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306905831 | South Lane Mental Health Services, Inc | Community/Behavioral Health | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2006-12-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SOUTH LANE MENTAL HEALTH SERVICES, INC. | 1345 Birch Ave, Cottage Grove, OR 97424 |
| Street Address |
1345 BIRCH AVE |
| City | COTTAGE GROVE |
| State | OR |
| Zip Code | 97424-1416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629141080 | Shirley Daine Howell | Occupational Therapy Assistant | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2006-11-15 |
| 1497362040 | Ashley Marie Kincaid | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2020-09-28 |
| 1164039897 | Lauren Appell | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2020-09-27 |
| 1720603285 | Jones David Hollister | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2020-06-10 |
| 1902421530 | Trevor Whitbread | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2020-06-09 |
| 1134766108 | Amy Mangum | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2019-12-09 |
| 1659922466 | Peter Christopher Deegan | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2019-09-23 |
| 1225687254 | Mary Peckenpaugh | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2019-09-11 |
| 1831758887 | Amanda Harp | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2019-06-12 |
| 1376108969 | Haley Cochell | Counselor | 1345 Birch Ave, Cottage Grove, OR 97424-1416 | 2019-05-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851936157 | Naomi Higgs | Physical Therapy Assistant | 515 Grant St, Cottage Grove, OR 97424 | 2019-11-10 |
| 1588131296 | Home Town Drugs of Cottage Grove, Inc. | Pharmacy | 1205 Hwy 99 North, Cottage Grove, OR 97424 | 2018-10-31 |
| 1215420625 | Zachary Booth | Student in an Organized Health Care Education/Training Program | 28188 Cottage Grove Lorane Rd, Cottage Grove, OR 97424 | 2018-06-11 |
| 1124404090 | Eileen Nittler | Social Worker | 1345 Birch Avenue, Cottage Grove, OR 97424 | 2015-08-03 |
| 1851799787 | Kathryn Brooks | Licensed Practical Nurse | 520 Patrick Loop, Cottage Grove, OR 97424 | 2014-12-09 |
| 1558767814 | Michele Renee Savage | Orthotic Fitter | 148 Gateway Blvd, Cottage Grove, OR 97424 | 2014-11-14 |
| 1730598558 | John Mansfield | Pharmacist | 120 Andrew Drive, Cottage Grove, OR 97424 | 2014-08-06 |
| 1700213493 | Aspen Injury Center LLC | Chiropractor | 1260 East Main Street, Cottage Grove, OR 97424 | 2013-09-26 |
| 1609172956 | Megan Olds | Counselor | 37 South 6th Street, Cottage Grove, OR 97424 | 2011-02-03 |
| 1144530726 | Monica G Radley | Counselor | 1345 Birch Ave., Cottage Grove, OR 97424 | 2010-10-15 |
| Find all providers in zip 97424 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952940298 | New Start Program | Clinic/Center | 12180 Se Market St, Portland, OR 97216-3923 | 2020-01-03 |
| 1992204697 | Sober Living Oregon Treatment Center | Clinic/Center | 10209 Se Division, Portland, OR 97266 | 2018-02-08 |
| 1851835722 | Changepoint, Inc | Clinic/Center | 1700 Nw 167th Place, Suite 240, Beaverton, OR 97006 | 2016-12-13 |
| 1518419779 | Bend Iop | Clinic/Center | 20354 Empire Ave, Bend, OR 97703-5710 | 2016-11-03 |
| 1447605258 | Crestview Recovery Services, LLC | Clinic/Center | 6027 Se Belmont St, Portland, OR 97215-1927 | 2016-04-29 |
| 1669856571 | Portland Iop, LLC | Clinic/Center | 748 Se 181st Ave, Portland, OR 97233-4945 | 2015-07-10 |
| 1194150326 | Goforth Inspired LLC | Clinic/Center | 345 Ne Baker Creek Rd, Mcminnville, OR 97128-2019 | 2013-09-06 |
| 1376788729 | Total Results LLC | Clinic/Center | 251 Ne Garden Valley Blvd, Suite I, Roseburg, OR 97470-1498 | 2008-12-12 |
| 1225241441 | Crc Health Oregon, LLC | Clinic/Center | 777 Murphy Rd, Medford, OR 97504-8425 | 2007-05-07 |
| 1336287010 | Seasons Counseling, Inc | Clinic/Center | 730 Hawthorne Ave Ne, Salem, OR 97301-4674 | 2007-02-02 |
| Find all providers with the same taxonomy | ||||
| City | COTTAGE GROVE |
| Zip Code | 97424 |
Please comment or provide details below to improve the information on SOUTH LANE MENTAL HEALTH SERVICES, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.