Organization
BEAUTIFUL RIVER CONSULTING, LLC DBA SUSTAINABLE SELF, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JOSEPH DOHERTY III PSY.D. (OWNER / PSYCHOLOGIST)
(503) 288-1213
Entity
Organization
Contact information
Practice address
4039 N MISSISSIPPI AVE STE 309, PORTLAND, OR 97227-1477
(503) 288-1213
Mailing address
PO BOX 3174, PORTLAND, OR 97208-3174
(503) 288-1213
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1628
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457404774
NPI
—
Enumeration date
09/23/2016
Last updated
09/23/2016
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