| Organization Name: | SECOND WIND MENTAL HEALTH CLINIC |
| NPI Number: | 1679957708 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAMARA LEE (SINGLE MEMBER LLC) |
| Mailing Address: | 11 Sw Brantley Drive Winston |
| State: | OR US |
| Postal Code: | 97496 |
| Phone Number: | 5416790366 |
| Fax Number: | 5416794821 |
| NPI Enumeration Date: | 07/18/2015 |
| NPI Last Update Date: | 11/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 200550033NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |