NPIMap

Organization Active NPI

Polk Yamhill & Marion Child Treatment Services Inc

  • Counselor
  • Salem, OR
National Provider Identifier
1760685176
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
POLK YAMHILL & MARION CHILD TREATMENT SERVICES INC
Practice address
965 Liberty St SE
Salem, OR 97302-4138
Phone
(503) 588-2004
Fax
(503) 588-2415
NPI assigned
Jun 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mrs. Bette Jane M Cox
Title
Office Manager
Phone
(503) 588-2004

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

965 Liberty St SE
Salem, OR 97302-4138

Mailing address

965 Liberty St SE
Salem, OR 97302-4138
Phone (503) 588-2004

Other identifiers 1

IdentifierTypeStateIssuer
042577MedicaidOR

Other names 1

  • Poyama Counseling Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422000050 OR Part B Supplier - Clinic/Group Practice 1557357993 Receives reassigned benefits from 4 practitioners
Practice locations: Salem, OR

National Provider Directory

National Provider Directory
Tax ID family
Polk Yamhill Marion Child Treatment Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

965 Liberty St SE
Salem, OR 97302
Phone (503) 588-2004

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1760685176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024138",
            "telephone_number": "503-588-2004",
            "fax_number": "503-588-2415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024138",
            "telephone_number": "503-588-2004",
            "fax_number": "503-588-2415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK YAMHILL & MARION CHILD TREATMENT SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "BETTE JANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-588-2004",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "042577",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poyama Counseling Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.