# FIFTH CORNER ACADEMY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fifth Corner Community Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033753231
- **Authorized official:** MRS. ROXANNE FRANKLIN WILSON BA, QMHA, PSS (PRESIDENT/PROGRAM ADMINISTRATOR)
- **Authorized official phone:** (503) 714-6306

## Contact information

- **Practice address:** 1900 NE HIGHWAY 99W STE K, MCMINNVILLE, OR 97128-2757
- **Practice address phone:** (503) 472-4511
- **Practice address fax:** (503) 714-6306
- **Mailing address:** 650 NE 2ND ST UNIT 133, MCMINNVILLE, OR 97128-4762
- **Mailing address phone:** (503) 472-4511
- **Mailing address fax:** (503) 714-6306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |
| 405300000X | Prevention Professional | — | NULL | — |
| 405300000X | Prevention Professional | — | — | — |

## Other

- **Enumeration date:** 10/30/2019
- **Last updated:** 03/28/2020