Organization
INTEGRATED YOUTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RON WIEBE (DIRECTOR OF OPERATIONS)
(541) 230-1630
Entity
Organization
Contact information
Practice address
673 NW JACKSON AVE, CORVALLIS, OR 97330-4832
(541) 230-1630
Mailing address
673 NW JACKSON AVE, CORVALLIS, OR 97330-4832
(541) 230-1630
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C2422
OR
101YM0800X
Mental Health Counselor
C2485
OR
1041C0700X
Clinical Social Worker
L4404
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
200950078NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144439019
NPI
OR
01
—
1164568895
NPI
OR
01
—
1245386440
NPI
OR
01
—
1285862938
NPI
OR
01
—
1881832095
NPI
OR
Enumeration date
01/26/2009
Last updated
07/16/2013
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