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Organization
FIFTH CORNER ACADEMY
Active
Organization
FIFTH CORNER ACADEMY
Active
Other names
Fifth Corner Community Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROXANNE FRANKLIN WILSON BA, QMHA, PSS (PRESIDENT/PROGRAM ADMINISTRATOR)
(503) 714-6306
Entity
Organization
Contact information
Practice address
1900 NE HIGHWAY 99W STE K, MCMINNVILLE, OR 97128-2757
(503) 472-4511
(503) 714-6306
Mailing address
650 NE 2ND ST UNIT 133, MCMINNVILLE, OR 97128-4762
(503) 472-4511
(503) 714-6306
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
133NN1002X
Nutrition Education Nutritionist
—
NULL
133NN1002X
Nutrition Education Nutritionist
—
—
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
172A00000X
Driver
—
NULL
172A00000X
Driver
—
—
1744R1102X
Research Study Specialist
—
NULL
1744R1102X
Research Study Specialist
—
—
174H00000X
Health Educator
—
NULL
174H00000X
Health Educator
—
—
175T00000X
Peer Specialist
—
NULL
175T00000X
Peer Specialist
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
405300000X
Prevention Professional
—
NULL
405300000X
Prevention Professional
—
—
Other
Enumeration date
10/30/2019
Last updated
03/28/2020
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