Organization
OREGON DEPARTMENT OF CORRECTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LINN REY MENZIE LCSW (BHS PROGRAM MANAGER)
(503) 280-6646
Entity
Organization
Contact information
Practice address
17734 SW SHASTA TRL, TUALATIN, OR 97062-8455
(503) 691-1718
Mailing address
17734 SW SHASTA TRL, TUALATIN, OR 97062-8455
(503) 691-1718
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
L4861
OR
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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