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Organization
NEW NARRATIVE
Active
Organization
NEW NARRATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELLE KENT (FINANCE DIRECTOR)
(503) 726-3752
Entity
Organization
Contact information
Practice address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3690
(503) 726-3691
Mailing address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3690
(503) 726-3691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
253J00000X
Foster Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104356
—
OR
Enumeration date
12/18/2006
Last updated
08/18/2021
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