| NPI | 1972044790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESIREE DAWN STANG Registered Lpc Intern 503-997-8863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR R4360) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-27 |