| NPI | 1083113146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORI CLARK Owner 503-997-0024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2024-01-06 |