Provider Demographics
NPI:1174392260
Name:DESCHUTES COUNTY JUVENILE COMMUNITY JUSTICE DEPARTMENT
Entity type:Organization
Organization Name:DESCHUTES COUNTY JUVENILE COMMUNITY JUSTICE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-322-7678
Mailing Address - Street 1:PO BOX 6005
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6005
Mailing Address - Country:US
Mailing Address - Phone:541-388-6671
Mailing Address - Fax:
Practice Address - Street 1:63360 NW BRITTA STREET
Practice Address - Street 2:BUILDING 1
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703
Practice Address - Country:US
Practice Address - Phone:541-388-6671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty