Organization
CHRISTA BRENNAN LLC
Active
Parent organization
BROKEN BOWL LLC
Other names
Broken Bowl LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BROKEN BOWL LLC
Authorized official
CHRISTA BRENNAN (OWNER)
(732) 275-2979
Entity
Organization
Contact information
Practice address
819 SE TAYLOR ST, PORTLAND, OR 97214-2385
(732) 275-2979
Mailing address
5010 SE 41ST AVE APT 106, PORTLAND, OR 97202-4278
(732) 275-2979
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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