Organization
BRIDGEVIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE REYNOLDS QMHA (COUNSELOR)
(503) 867-4270
Entity
Organization
Contact information
Practice address
707 NW EVERETT ST, PORTLAND, OR 97209-3517
(503) 222-4906
Mailing address
3056 NE HOLLADAY ST APT 303, PORTLAND, OR 97232-2485
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
171MOOOOOX
OR
Other
Enumeration date
01/29/2007
Last updated
08/22/2020
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