| NPI | 1134706849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA SHORT Member 971-312-2091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2021-03-27 |