Organization
MIDSTREAM
Active
Other names
Portland Trauma Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
TARA CROWLEY LCSW (OFFICE MANAGER)
(503) 715-0910
Entity
Organization
Contact information
Practice address
1020 SW TAYLOR ST, SUITE 400, PORTLAND, OR 97205-2543
(503) 715-0910
(503) 715-0911
Mailing address
1020 SW TAYLOR ST, SUITE 400, PORTLAND, OR 97205-2543
(503) 715-0910
(503) 715-0911
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L5721
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500649487
—
OR
Enumeration date
07/19/2012
Last updated
07/29/2014
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