Organization
TETRALEMMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DAVIS LCSW (OWNER)
(541) 714-5123
Entity
Organization
Contact information
Practice address
302 NE PLYMOUTH CIR, CORVALLIS, OR 97330-4126
(541) 714-5123
Mailing address
302 NE PLYMOUTH CIR, CORVALLIS, OR 97330-4126
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500783541
—
OR
Enumeration date
07/13/2020
Last updated
01/08/2021
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