Organization
HEATHER GREENE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER GREENE LCSW (OWNER)
(971) 724-7393
Entity
Organization
Contact information
Practice address
12555 SW 1ST ST, BEAVERTON, OR 97005-0546
(971) 724-7393
Mailing address
18005 SW EWEN DR, BEAVERTON, OR 97003-3818
(971) 724-7393
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
L4691
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912204546
—
OR
Enumeration date
05/04/2017
Last updated
05/04/2017
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