| NPI | 1770022493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA MARIE SEPARA Ma, Lpc 503-724-0943 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR C4399) |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2017-02-22 |