Provider Demographics
NPI:1386953891
Name:SNOW PEAK YOUTH CAMP, INC.
Entity type:Organization
Organization Name:SNOW PEAK YOUTH CAMP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:JENIVEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-394-4294
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:OR
Mailing Address - Zip Code:97374-0482
Mailing Address - Country:US
Mailing Address - Phone:503-394-4294
Mailing Address - Fax:503-394-7096
Practice Address - Street 1:44644 CAMP MORRISON DR
Practice Address - Street 2:BOX 482
Practice Address - City:SCIO
Practice Address - State:OR
Practice Address - Zip Code:97374-9336
Practice Address - Country:US
Practice Address - Phone:503-394-4294
Practice Address - Fax:503-394-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty