Organization
CONNECTIVE THERAPY COLLECTIVE
Active
Parent organization
1053674949
Other names
Connective Therapy Collective, Connective Sex Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
1053674949
Authorized official
ANGELA GUNN LCSW CST (CEO)
(971) 361-8303
Entity
Organization
Contact information
Practice address
4531 SE BELMONT ST STE 117, PORTLAND, OR 97215-1675
(414) 550-0257
Mailing address
5510 N COMMERCIAL AVE, PORTLAND, OR 97217-2340
(971) 361-8303
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
11/06/2019
Last updated
02/01/2021
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