Organization
LUTHERAN COMMUNITY SERVICES NORTHWEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELIA CLARK (CREDENTIALING)
(541) 201-3973
Entity
Organization
Contact information
Practice address
2545 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6423
(541) 883-3471
(541) 883-3524
Mailing address
2545 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6423
(541) 883-3471
(541) 883-3524
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026825000
BCBS PROVIDER #
OR
05
—
090450
—
OR
Enumeration date
03/26/2007
Last updated
05/16/2025
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