| NPI | 1972211324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA WITHAM Owner/Provider 503-455-7656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2024-06-25 |