| NPI | 1457404410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN BURNELL Program Director 503-621-8735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR 63212) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 02-R-13) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2020-08-22 |