| NPI | 1417486671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANE NIELSEN Owner 503-765-6209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2024-05-21 |