Provider Demographics
NPI:1538936265
Name:WILLAMETTE VALLEY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:WILLAMETTE VALLEY MENTAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-330-5788
Mailing Address - Street 1:3100 E HAWORTH AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2197
Mailing Address - Country:US
Mailing Address - Phone:503-330-5788
Mailing Address - Fax:
Practice Address - Street 1:3100 E HAWORTH AVE STE 270
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2197
Practice Address - Country:US
Practice Address - Phone:503-330-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty