Provider Demographics
NPI:1154619963
Name:OSOA THERAPY
Entity type:Organization
Organization Name:OSOA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A&D COUNSELOR, CLINICAL SOCIAL WORK
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ASHTON-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II, LCSW
Authorized Official - Phone:541-429-9000
Mailing Address - Street 1:PO BOX 1703
Mailing Address - Street 2:114 SE 1ST ST
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0540
Mailing Address - Country:US
Mailing Address - Phone:541-429-9000
Mailing Address - Fax:855-738-7698
Practice Address - Street 1:114 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2204
Practice Address - Country:US
Practice Address - Phone:541-429-9000
Practice Address - Fax:855-738-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-09-56101YA0400X
OR0621201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty