Organization
SOUTH LANE MENTAL HEALTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESE NADINE MASTIN MA (QUALITY MANAGEMENT DIRECTOR)
(541) 767-4176
Entity
Organization
Contact information
Practice address
1345 BIRCH AVE, COTTAGE GROVE, OR 97424-1416
(541) 942-3939
(541) 942-9310
Mailing address
1345 BIRCH AVE, COTTAGE GROVE, OR 97424-1416
(541) 942-3939
(541) 942-9310
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
102491-83
OR
Other
Enumeration date
08/25/2017
Last updated
07/21/2022
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