NPIMap

Organization Active NPI

Northwest Human Services, Inc.

Doing business as West Salem Clinic Mental Health

  • Federally Qualified Health Center (FQHC)
  • Salem, OR
National Provider Identifier
1194082867
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHWEST HUMAN SERVICES, INC.
Doing business as
West Salem Clinic Mental Health
Practice address
1233 Edgewater St NW Ste B
Salem, OR 97304-4049
Phone
(503) 588-5816
Fax
(503) 588-5803
NPI assigned
Apr 18, 2012
Last updated
Aug 18, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST HUMAN SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Leathley
Title
Chief Executive Officer
Phone
(503) 588-5828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1233 Edgewater St NW Ste B
Salem, OR 97304-4049

Mailing address

681 Center St NE
Salem, OR 97301-3722
Phone (503) 588-5828

Other names 1

  • West Salem Clinic Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120725001026 OR Part A Provider - Federally Qualified Health Center (FQHC) 7012825797 Practice locations: Salem, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194082867. Details of each certification follow.

Federally qualified health center certification: CCN 381930

Legal name
NORTHWEST HUMAN SERVICES INC
Doing business as
WEST SALEM CLINIC MENTAL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 26, 2012
Last certification
Jul 26, 2012
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 9, 1982 in OR
Enrollment address
1233 Edgewater St NW
Ste B
Salem, OR 97304-4049

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Northwest Human SVCS DB6 organizations share this tax ID, including this one
Part of
Northwest Human SVCS DB

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1233 Edgewater St NW
Ste C
Salem, OR 97304

1245 Edgewater St NW
Salem, OR 97304
Phone (503) 378-7526

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Oracio Larios Individual Corporate DirectorBoard Member May 1, 2024
William E Williams Individual Corporate DirectorBoard Member Feb 23, 2016
Matthew Emery Individual Corporate OfficerCfo Jan 3, 2022
W-2 Managing EmployeeCfo Jan 3, 2022
Ana Lopez Individual Corporate DirectorBoard Member Jan 1, 2026
Yolanda Harris Individual Corporate DirectorBoard Member Aug 26, 2025
James G Christian Individual Corporate DirectorBoard Member Aug 25, 2020
Susan Scott Individual Corporate DirectorBoard Member Mar 29, 2011
Kimberly Leathley Individual Corporate OfficerCeo Oct 1, 2024
W-2 Managing EmployeeCeo Oct 1, 2024
Anne Griffin Individual Corporate DirectorBoard Member Mar 1, 2026
Larry F Goodreau Individual Corporate DirectorBoard Member Mar 4, 2008
Jan Margosian Individual Corporate DirectorBoard Member Oct 30, 2012
Robert Moore Individual Corporate DirectorBoard Member Jan 1, 2023
Michael B Wise Individual Corporate DirectorBoard Member Mar 4, 2008
Eric Tweed Individual Corporate DirectorBoard Member Feb 27, 2018
Ashley Jackson Individual Corporate DirectorBoard Member Aug 1, 2024

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787011200000",
    "number": "1194082867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "681 CENTER ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013722",
            "telephone_number": "503-588-5828",
            "fax_number": "503-588-5852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 EDGEWATER ST NW STE B",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044049",
            "telephone_number": "503-588-5816",
            "fax_number": "503-588-5803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST HUMAN SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST HUMAN SERVICES, INC.",
        "enumeration_date": "2012-04-18",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A",
        "authorized_official_last_name": "LEATHLEY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "503-588-5828"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Salem Clinic Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Salem Clinic Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.