| NPI | 1285839019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN JACQUOT Administrator 503-352-0468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR MD, PMHNP LPC) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2017-07-28 |