WILD GEESE MENTAL HEALTH LLC (NPI# 1598126310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598126310 |
| Entity Type | Organization |
| Organization Name | WILD GEESE MENTAL HEALTH LLC |
| Practice Address |
636 Sw 2nd St Corvallis OR 97333-4442 |
| Practice Telephone | 5416362855 |
| Practice Fax Number | 5416101506 |
| Mailing Telephone | 5416362855 |
| Mailing Fax Number | 5416101506 |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2016-03-08 |
| Authorized Official Name | AYELET AMITTAY (REGISTERED AGENT) |
| Authorized Official Telephone | 5416362855 |
| Authorized Official Credential | PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
201150061NP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
636 SW 2ND ST |
| City | CORVALLIS |
| State | OR |
| Zip Code | 97333-4442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932133303 | Bruce William Austin | Dentist | 636 Sw 2nd St, Corvallis, OR 97333-4442 | 2006-07-10 |
| 1629341946 | Tina Amorok | Psychologist | 636 Sw 2nd St, Corvallis, OR 97333-4442 | 2012-02-16 |
| 1457503260 | Dulcy K Neeley | Counselor | 636 Sw 2nd St, Corvallis, OR 97333-4442 | 2008-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437629037 | Collin Korthauer | Case Manager/Care Coordinator | 1650 Sw 45th Place, Corvallis, OR 97333 | 2018-11-27 |
| 1477079937 | Adam Johnson | Counselor | 518 Sw 3rd, Corvallis, OR 97333 | 2017-08-16 |
| 1386961522 | Michael S. Hanson | Counselor | 518 Sw 3rd St., Corvallis, OR 97333 | 2010-04-28 |
| 1134392376 | Corvallis Physical Therapy Inc | Physical Therapist | 230 Sw 3rd Street Suite 208, Corvallis, OR 97333 | 2008-04-09 |
| 1154529600 | Linda S Lavallee Conniff | Social Worker | 216 Sw Madison Av, #9 10, Corvallis, OR 97333 | 2007-07-06 |
| 1235337056 | Robert R Conniff | Social Worker | 216 Sw Madison Ave, 2, Corvallis, OR 97333 | 2007-07-03 |
| 1619178829 | Trillium Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 4455 Highway North West Highway 20, Corvallis, OR 97333 | 2007-05-29 |
| 1437368867 | Margaret Anne Cooper | Physical Therapist | 230 Sw 3rd Street, Suite 208, Corvallis, OR 97333 | 2007-05-22 |
| 1801009311 | Madeline Elizabeth Rubin | Social Worker | 216 Sw Madison Avenue, Suite 14, Corvallis, OR 97333 | 2007-05-08 |
| 1780707174 | Wheeler John Dale | Internal Medicine | 5060 Sw Philomath Blvd, # 512, Corvallis, OR 97333 | 2007-04-09 |
| Find all providers in zip 97333 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922314590 | Ayelet Amittay | Nurse Practitioner | 975 Nw Spruce Ave, Ste 102, Corvallis, OR 97330-2297 | 2010-08-20 |
| 1265534903 | Linda Frances Fortune | Nurse Practitioner | 1300 Nw Harrison, Suite 130, Corvallis, OR 97330 | 2006-09-02 |
| 1932674777 | Justin Eugene Hoyt | Nurse Practitioner | 4455 Ne Highway 20, Corvallis, OR 97330-9695 | 2018-10-08 |
| 1104272871 | Luiza Gabriela Marinescu | Nurse Practitioner | 3509 Nw Samaritan Dr, Suite 215, Corvallis, OR 97330-3893 | 2016-05-11 |
| 1285862938 | Gail Wiebe | Nurse Practitioner | 673 Nw Jackson Ave, Corvallis, OR 97330-4832 | 2009-07-01 |
| 1356589303 | Tania R May | Nurse Practitioner | 3509 Nw Samaritan Dr, Corvallis, OR 97330-3766 | 2009-01-29 |
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|---|---|---|---|---|
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| 1629687892 | Robin Sue Finney | Nurse Practitioner | 1957 Thompson Rd Ste I, Coos Bay, OR 97420-2040 | 2020-07-23 |
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| 1447871678 | Monarch Mental Health LLC | Nurse Practitioner | 1927 Channel St, North Bend, OR 97459-1826 | 2020-04-28 |
| 1104446681 | Skycloud Psychiatry LLC | Nurse Practitioner | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 |
| 1366071607 | Med Rx Partners, P.C. | Nurse Practitioner | 12115 Sw 70th Ave Ste 202, Tigard, OR 97223-9648 | 2020-04-08 |
| 1417583170 | Brittany Joy Monson | Nurse Practitioner | 12115 Sw 70th Ave, Tigard, OR 97223-9647 | 2020-03-13 |
| 1073147716 | Paradigm Mental Health and Wellness LLC | Nurse Practitioner | 724 S Central Ave Ste 101d, Medford, OR 97501-7808 | 2020-03-02 |
| 1730712290 | Lucy Anne Bloedon | Nurse Practitioner | 4020 Sw Iowa St, Portland, OR 97221-3423 | 2020-02-12 |
| Find all providers with the same taxonomy | ||||
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| 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.