Provider Demographics
NPI:1619772829
Name:TRADITIONAL WAYS HEALING COLLECTIVE
Entity type:Organization
Organization Name:TRADITIONAL WAYS HEALING COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:CRM, PSS, QMHA, CADC
Authorized Official - Phone:541-281-9330
Mailing Address - Street 1:PO BOX 1694
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0095
Mailing Address - Country:US
Mailing Address - Phone:541-281-9330
Mailing Address - Fax:
Practice Address - Street 1:412 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2624
Practice Address - Country:US
Practice Address - Phone:541-281-9330
Practice Address - Fax:541-205-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable