| NPI | 1841000957 | 
|---|---|
| Doing Business As | HOLLY WIGMORE | 
| Entity Type | Organization | 
| Authorized Contact | HOLLY WIGMORE Practice Owner 503-843-8862 | 
| Organization Subpart ? | Yes | 
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | 
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health | 
| Enumeration Date | 2025-01-10 | 
| Last Update Date | 2025-01-10 |