| NPI | 1700164878 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | DAVID CORY BRILLHART Clinical Psychologist 503-400-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OR 2162) |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2012-07-27 |