Provider Demographics
NPI:1306902697
Name:HERON COUNSELING SERVICES CORPORATION
Entity type:Organization
Organization Name:HERON COUNSELING SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DELL
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CACDII
Authorized Official - Phone:503-474-2024
Mailing Address - Street 1:105 NE 8TH ST
Mailing Address - Street 2:P.O. BOX 1579
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4909
Mailing Address - Country:US
Mailing Address - Phone:503-474-2024
Mailing Address - Fax:503-474-4454
Practice Address - Street 1:105 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4909
Practice Address - Country:US
Practice Address - Phone:503-474-2024
Practice Address - Fax:503-474-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMB000039OtherMMIS ELECTRONIC BILLING
OR165726Medicaid