| NPI | 1689110868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY FILLEY Owner 503-765-5856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201405875) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |