STALEY WOOD MIMS

PORTLAND, OR
NPI1023155207
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
Additional Taxonomies372600000X Adult Companion
Enumeration Date2007-01-30
Last Update Date2007-07-08
Business Address
-- STALEY WOOD MIMS QMHP MED
2330 NE SISKIYOU ST
PORTLAND, OR 97212-2471
Phone number: 503-528-0757
Mailing Address
-- STALEY WOOD MIMS QMHP MED
3602 SE 28TH PL APT 15
PORTLAND, OR 97202-3070
Phone number: 503-771-0968
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