| NPI | 1073936522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACY COOPER Therapist 503-508-5819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR C3445) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2017-04-14 |