| NPI | 1972964021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EIN O'LEARY Owner 503-533-7111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201150097NP) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C3432) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2016-03-17 |