| NPI | 1326432154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE TIERNEY Clinic Director 503-226-2203 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2015-03-18 |