Organization
TERAS INTERVENTIONS AND COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP BROYLES BS,CADCII (EXECUTIVE DIRECTOR)
(503) 719-5250
Entity
Organization
Contact information
Practice address
3945 SE HAWTHORNE BLVD, PORTLAND, OR 97214-5241
(503) 719-5250
Mailing address
3945 SE HAWTHORNE BLVD, PORTLAND, OR 97214-5241
(503) 719-5250
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500658984
—
OR
Enumeration date
05/16/2011
Last updated
11/08/2013
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