| NPI | 1255872032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KONRAD A VON WALTHER Owner 503-985-9640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 6961) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-02-15) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-16 |