POLK COUNTY MENTAL HEALTH (NPI# 1770603532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770603532 |
| Entity Type | Organization |
| Organization Name | POLK COUNTY MENTAL HEALTH |
| Practice Address |
182 Sw Academy St Ste 304 Dallas OR 97338-1900 |
| Practice Telephone | 5036239289 |
| Practice Fax Number | 5038311726 |
| Mailing Telephone | 5038516737 |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-07-02 |
| Authorized Official Name | SERGIO GUTIERREZ (MENTAL HEALTH COUNSELOR I) |
| Authorized Official Telephone | 5036239289 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
00-07-15 | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | CADC I | 00-07-15 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295857977 | Polk County Mental Health | Counselor | 557 21st St Se, Salem, OR 97301-6526 | 2007-04-04 |
| 1861933863 | Polk County Mental Health | Social Worker | 182 Sw Academy St, Dallas, OR 97338-1996 | 2017-03-10 |
| 1174892301 | Polk County Mental Health | Clinic/Center | 182 Sw Academy St, Suite304, Dallas, OR 97338-1922 | 2011-12-16 |
| 1861616344 | Polk County Mental Health | Case Management | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-04-13 |
| 1366569998 | Polk County Mental Health | Case Management | 182 Sw Academy St, Suite 304, Dallas, OR 97338-1922 | 2007-03-26 |
| 1154447068 | Polk County Mental Health | Case Management | 182 Sw Academy St, Suite # 304, Dallas, OR 97338-1922 | 2007-03-22 |
| 1457477333 | Polk County Mental Health | Community/Behavioral Health | 182 Sw Academy St, Suite 304, Dallas, OR 97338-1922 | 2007-03-22 |
| 1639295694 | Polk County Mental Health | Case Management | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-03-21 |
| Street Address |
182 SW ACADEMY ST STE 304 |
| City | DALLAS |
| State | OR |
| Zip Code | 97338-1900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770620684 | Timothy N Taylor | Nurse Practitioner | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-01-31 |
| 1578097382 | Gabriella Cordy | Social Worker | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2017-04-18 |
| 1194171884 | Emily Mitchell | Counselor | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2016-05-11 |
| 1528332434 | Nathen Tyler Van Slochteren | Counselor | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2012-02-24 |
| 1902014830 | Dana Lynne Stuart | Social Worker | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-05-21 |
| 1669689477 | Jennifer Lynn Webb | Social Worker | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-05-17 |
| 1376760736 | Barbara J Schram | Case Manager/Care Coordinator | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-04-19 |
| 1861616344 | Polk County Mental Health | Case Management | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-04-13 |
| 1861616963 | Jodi L Cabell | Social Worker | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-04-12 |
| 1487877601 | Patricia Kinsey Miller | Counselor | 182 Sw Academy St Ste 304, Dallas, OR 97338-1900 | 2007-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164932042 | Stephanie Marie Renfro | Massage Therapist | 289 E Ellendale Ave #601, Dallas, OR 97338 | 2017-10-05 |
| 1588185953 | Herbert Starr Woodward IIi | Dentist | 201 Se Washington St, Dallas, OR 97338 | 2017-07-06 |
| 1851708077 | David Mooso | Pharmacist | 321 Nw Kings Valley Highway, Dallas, OR 97338 | 2014-07-21 |
| 1841615556 | Leslie Lytle | Counselor | 1020 Sw Maple St., Dallas, OR 97338 | 2014-03-04 |
| 1205265493 | Chung-fan Ni | Counselor | 182 S. W. Academy St., Academy Building, Dallas, OR 97338 | 2013-11-07 |
| 1215204300 | Ron Fritz | Counselor | 239 E. Ellendale, Suite 602, Dallas, OR 97338 | 2011-11-17 |
| 1235420167 | Deborah Kennedy | Counselor | 527 Ne Fern Ave, Dallas, OR 97338 | 2011-04-26 |
| 1821229774 | Chelsea Ruhoff Lee | Physician Assistant | 1000 Se Uglow Avenue, Flaming Medical Center, Dallas, OR 97338 | 2009-07-27 |
| 1013128560 | Larry J Vuylsteke | Social Worker | 182 S.w. Academy, Dallas, OR 97338 | 2007-05-25 |
| 1093926123 | Justin W Reed | Counselor | Academy Building, 182 S.w. Academy St. Suite 304, Dallas, OR 97338 | 2007-05-24 |
| Find all providers in zip 97338 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316553019 | Trinity Health System | Clinic/Center | 13101 Preston Rd Ste 425, Dallas, TX 75240-5278 | 2020-09-17 |
| 1205390325 | Pyramid Health Care Inc. | Clinic/Center | 100 Upper Demunds Rd, Dallas, PA 18612-8811 | 2019-01-23 |
| 1518405307 | Envision Hope | Clinic/Center | 5151 Belt Line Rd, Suite 575, Dallas, TX 75254-7507 | 2017-02-01 |
| 1235448218 | Homeward Bound, Inc | Clinic/Center | 315 Sunset Ave, Dallas, TX 75208-4606 | 2010-09-24 |
| 1881725752 | West Texas Counseling and Rehabilitation of Dallas, Inc. | Clinic/Center | 1808 Market Center Blvd, Dallas, TX 75207-3315 | 2007-03-09 |
| 1528071214 | Nexus Recovery Center, Inc. | Clinic/Center | 8733 La Prada Dr, Dallas, TX 75228-5036 | 2006-08-14 |
| 1134685993 | I360 Life Development, LLC | Clinic/Center | 6600 Lbj Fwy Ste 240, Dallas, TX 75240-6550 | 2019-02-18 |
| 1003284100 | Enterhealth | Clinic/Center | 8222 Douglas Ave, Dallas, TX 75225-5923 | 2015-09-04 |
| 1053509802 | Lenae White, M.d., P.a. | Clinic/Center | 8222 Douglas Ave, Ste. 390, Dallas, TX 75225-5923 | 2007-10-05 |
| 1750407250 | Dallas Challenge Inc | Clinic/Center | 201 S Tyler St, Dallas, TX 75208-4934 | 2007-03-22 |
| Find all providers in DALLAS | ||||
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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.