Basic Information
| Provider Information | |||||||||
| NPI: | 1801094354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRILLIUM FAMILY SERVICES OF CENTRAL OREGON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2065 NW HILL ST | ||||||||
| Address2: | APT C | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977011336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413184845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 63660 BRITTA ST, BLDG 1 | ||||||||
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| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413184845 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TOMLINSON | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY SERVICES COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5413184845 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.