Umpqua Family Therapy LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Roseburg, OR. Organization (NPI-2).
NPI number1104401439
StatusActive
Last updated in NPPESAug 23, 2021
Details
- NPI
- 1104401439
- Entity type
- Organization (NPI-2)
- Legal business name
- Umpqua Family Therapy LLC
- Organization subpart
- No
- Enumeration date
- Mar 17, 2021
- Certification date
- Aug 23, 2021
- Last updated
- Aug 23, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
| 251B00000X | Case Management | – | – | |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Other names
- Meredith Concepcion (Doing Business As)
- Meredith Concepcion, Lcsw (Doing Business As)
- Meredith A Yost-Concepcion (Other Name)
Practice location
1299 Nw Ellan St Ste 2Roseburg, OR 97470-2031
Phone 458-802-3883 · Fax 541-900-1840
Mailing address
1299 Nw Ellan St Ste 2Roseburg, OR 97470-2031
Phone 458-802-3883 · Fax 541-900-1840
Authorized official
Meredith Ann Concepcion
Owner/Provider
4588023883
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