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FIFTH CORNER ACADEMY NPI 1033753231


NPI Information

NPI: 1033753231
Provider Name: FIFTH CORNER ACADEMY

Doing Business As: FIFTH CORNER COMMUNITY SERVICES

Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Organization

Specialization: Child & Adolescent Psychiatry

Address:
1900 NE HIGHWAY 99W STE K
MCMINNVILLE, OR
ZIP 97128
Phone: (503) 472-4511
Get Directions

FIFTH CORNER ACADEMY is a child and adolescent psychiatry psychiatry neurology in Mcminnville, OR. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. FIFTH CORNER ACADEMY NPI is 1033753231. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Fifth Corner Community Services.

The provider's business location address is:

1900 NE HIGHWAY 99W STE K
MCMINNVILLE, OR
ZIP 97128-757
Phone: (503) 472-4511
Fax: (503) 714-6306

The provider's authorized official is Roxanne Franklin Wilson .
The authorized official title is President/program Administrator and has the following contact phone number (503) 714-6306.

The enumeration date for this NPI number is 10/30/2019 and was last updated on 3/28/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental HealthNo
2133NN1002XNutritionistNutrition, EducationNo
3163W00000XRegistered NurseNo
4171M00000XCase Manager/Care CoordinatorNo
5172A00000XDriverNo
61744R1102XSpecialistResearch StudyNo
7174H00000XHealth EducatorNo
8175T00000XPeer SpecialistNo
9405300000XPrevention ProfessionalNo
102084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11851475099MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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