Provider Demographics
NPI:1285728105
Name:GATEWAY COUNSELING CENTER, P.C.
Entity type:Organization
Organization Name:GATEWAY COUNSELING CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-942-0040
Mailing Address - Street 1:1445 GATEWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1224
Mailing Address - Country:US
Mailing Address - Phone:541-942-0040
Mailing Address - Fax:541-942-0040
Practice Address - Street 1:1445 GATEWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1224
Practice Address - Country:US
Practice Address - Phone:541-942-0040
Practice Address - Fax:541-942-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3015251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135160Medicare PIN