| NPI | 1992138309 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE WILLAMETTE FALLS CHILD ADOLESCENT OUTPATIENT PSYCHIATRY |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Secretary For Enrollments 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2025-07-04 |