NPIMap

Organization Active NPI

Second Wind Mental Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Winston, OR
National Provider Identifier
1679957708
Registry record updated Nov 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
200550033NP Issued in OR
Legal business name
SECOND WIND MENTAL HEALTH CLINIC
Practice address
11 SW Brantley Drive
Winston, OR 97496
Phone
(541) 679-0366
Fax
(541) 679-4821
NPI assigned
Jul 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2015

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

Authorized official

Name
Tamara Lee, APRNNPI 1992720965
Title
Single Member LLC
Phone
(541) 679-0366

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 200550033NP OR Primary

Addresses

Primary practice location

11 SW Brantley Drive
Winston, OR 97496

Mailing address

11 SW Brantley Drive
Winston, OR 97496
Phone (541) 679-0366

Other identifiers 1

IdentifierTypeStateIssuer
363LP0808XMedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151113001380 OR Part B Supplier - Clinic/Group Practice 2769792183 Receives reassigned benefits from 7 practitioners
Practice locations: Winston, OR

National Provider Directory

National Provider Directory

Locations

11 SW Brantley Dr
Winston, OR 97496
Phone (541) 679-0366

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447372800000",
    "number": "1679957708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 SW BRANTLEY DRIVE",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "97496",
            "telephone_number": "541-679-0366",
            "fax_number": "541-679-4821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 SW BRANTLEY DRIVE",
            "city": "WINSTON",
            "state": "OR",
            "postal_code": "97496",
            "telephone_number": "541-679-0366",
            "fax_number": "541-679-4821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND WIND MENTAL HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2015-11-13",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "SINGLE MEMBER LLC",
        "authorized_official_telephone_number": "541-679-0366",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OR",
            "license": "200550033NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363LP0808X",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.