Organization
SECOND WIND MENTAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA LEE APRN (SINGLE MEMBER LLC)
(541) 679-0366
Entity
Organization
Contact information
Practice address
11 SW BRANTLEY DRIVE, WINSTON, OR 97496
(541) 679-0366
(541) 679-4821
Mailing address
11 SW BRANTLEY DRIVE, WINSTON, OR 97496
(541) 679-0366
(541) 679-4821
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
200550033NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363LP0808X
—
OR
Enumeration date
07/18/2015
Last updated
11/13/2015
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