NPIMap

Organization Active NPI

Polk County Mental Health

  • Community/Behavioral Health Agency
  • Dallas, OR
National Provider Identifier
1457477333
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
POLK COUNTY MENTAL HEALTH
Practice address
182 SW Academy St
Suite 304
Dallas, OR 97338-1922
Phone
(503) 623-9289
Fax
(503) 831-1726
NPI assigned
Mar 22, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. David Manitsas, PSY.D.
Title
Supervisor
Phone
(503) 623-9289

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

182 SW Academy St
Suite 304
Dallas, OR 97338-1922

Mailing address

182 SW Academy St
Suite 304
Dallas, OR 97338-1922
Phone (503) 623-9289

National Provider Directory

National Provider Directory
Tax ID family
Polk County Mental Heal11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457477333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST",
            "address_2": "SUITE 304",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381922",
            "telephone_number": "503-623-9289",
            "fax_number": "503-831-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST",
            "address_2": "SUITE 304",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381922",
            "telephone_number": "503-623-9289",
            "fax_number": "503-831-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK COUNTY MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANITSAS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "503-623-9289",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.