Organization
TEEN CHALLENGE INTERNATIONAL PACIFIC NORTHWEST CENTERS
Active
Other names
Life Renewal - Portland Outpatient, Life Renewal - Shedd Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN NELSON (COO)
(971) 255-0658
Entity
Organization
Contact information
Practice address
18600 SE MCLOUGHLIN BLVD, MILWAUKIE, OR 97267-6723
(971) 255-0658
Mailing address
18600 SE MCLOUGHLIN BLVD, MILWAUKIE, OR 97267-6723
(971) 255-0658
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1712386
—
AK
05
—
2173185
—
WA
05
—
500711843
—
OR
05
—
90591
—
MT
Enumeration date
08/08/2016
Last updated
02/28/2024
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