| NPI | 1730564139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DAVID HOLLADAY Medical Director 503-477-4969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OR 156792) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2015-07-27 |