| NPI | 1700396793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH JOHN MACKIE Owner 971-207-5010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C2538) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 07-09-29) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2022-02-08 |