Organization · NPI-2

148835

Clinic/Center, Mental Health (Including Community Mental Health Center) · Portland, OR

NPI number1861382384
StatusActive
Last updated in NPPESJul 7, 2025

Details

NPI
1861382384
Entity type
Organization (NPI-2)
Legal business name
148835
Organization subpart
No
Enumeration date
Jul 7, 2025
Certification date
Jul 7, 2025
Last updated
Jul 7, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Practice location

529 Se Grand Ave
Portland, OR 97214-2232

Phone 971-270-0468

Mailing address

529 Se Grand Ave
Portland, OR 97214-2232

Phone 971-270-0468

Authorized official

Rshaffer E Shaffer
Member
8056570097

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