| NPI | 1003170507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE ANN RUSSELL Clincial Manager 503-312-9163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR R2646, R2647) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2013-10-21 |