Organization
RADICLE ORIGINS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER HAYDEN LPC (OWNER)
(626) 565-2816
Entity
Organization
Contact information
Practice address
10700 SW BEAVERTON HILLSDALE HWY STE 560, BEAVERTON, OR 97005-4791
(626) 565-2816
Mailing address
PO BOX 17221, PORTLAND, OR 97217-0221
(626) 565-2816
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
07/26/2024
Last updated
07/26/2024
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