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Mr. John Walter Lee IV
Addiction (Substance Use Disorder) Counselor in Coburg, Oregon
NPI 1629780770

John Walter Lee IV is an Addiction (Substance Use Disorder) Counselor based in Coburg, OR and is specialized in Addiction (Substance Use Disorder). John Walter Lee IV practices in Coburg, OR. The NPI Number for John Walter Lee IV is 1629780770 and holds a License No. T-22-2191 (Oregon).

The current practice location address for John Walter Lee IV is 1 Serenity Ln, Coburg, OR and can be reached out via phone at 541-204-2276.

Location: 1 Serenity Ln, Coburg, OR, 97408-1313
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1629780770
Provider Name
John Walter Lee IV
Credential
Provider Entity Type
Individual
Gender
Male
Address
1 Serenity Ln, Coburg, OR, 97408-1313
Phone Number
541-204-2276
Fax Number
Provider Enumeration Date
12/20/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1 Serenity Ln
City
Coburg
State
Oregon
Zip
97408-9350
Phone Number
541-204-2276
Fax Number
person
Provider Business Mailing Address Details
Address
1 Serenity Ln
City
Coburg
State
Oregon
Zip
97408-9350
Phone Number
541-204-2276
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
T-22-2191 (Oregon)
Definition
Definition to come...
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