Organization
COUNTY OF POLK
Active
Other names
Polk County Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG P HANSEN (POLK COUNTY ADMINISTRATIVE OFFICER)
(503) 623-8173
Entity
Organization
Contact information
Practice address
182 SW ACADEMY, SUITE 304, DALLAS, OR 97338-1922
(503) 623-9289
(503) 831-1726
Mailing address
182 SW ACADEMY, POLK COUNTY MEDICAL HEALTH SUITE 310, DALLAS, OR 97338-1922
(503) 623-9317
(503) 623-2731
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152660
—
OR
Enumeration date
07/09/2006
Last updated
09/05/2007
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