| NPI | 1215228150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENN CODY-WALD President 503-230-0518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: OR 2018) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2011-04-26 |