person
Raina Wickham
Mental Health Counselor in Philomath, Oregon
NPI 1457686073

Raina Wickham is a Mental Health Counselor based in Corvallis, OR and is specialized in Mental Health. Raina Wickham practices in Philomath, OR. The NPI Number for Raina Wickham is 1457686073 and holds a License No. 11-12-75 (Oregon).

The current practice location address for Raina Wickham is 1229 Main Street, Suite 105, Philomath, OR and can be reached out via phone at 541-609-1305 and via fax at 541-714-3770. You can also correspond with Raina Wickham through the mailing address at 24971 BLUEROCK LN, CORVALLIS, OR - 97333-9554 (mailing address contact number: 541-609-1305).

Location: 1229 Main Street, Suite 105, Philomath, OR, 97333-9554
person
Provider Profile Details
NPI Number
1457686073
Provider Name
Raina Wickham
Credential
Provider Entity Type
Individual
Gender
Female
Address
1229 Main Street, Suite 105, Philomath, OR, 97333-9554
Phone Number
541-609-1305
Fax Number
541-714-3770
Provider Enumeration Date
10/15/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
500658765 05 OR
institution
Provider Business Practice Location Address Details
Address
1229 Main Street, Suite 105
City
State
Zip
97370
Phone Number
541-609-1305
Fax Number
541-714-3770
person
Provider Business Mailing Address Details
Address
1229 Main Street, Suite 105
City
State
Zip
97370
Phone Number
541-609-1305
Fax Number
541-714-3770
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
MASTERS - PSU (Oregon)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
11-12-75 (Oregon)
Definition
Definition to come...
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