| NPI | 1265740096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIRZAH D JACOB Practice Owner 503-407-9232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C1780) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C1780) |
| 101YM0800X Counselor, Mental Health (Licence: OR C1780) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2023-06-01 |