Organization
ST MARY'S HOME FOR BOYS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL COLE (ASSISTANT DIRECTOR)
(503) 259-3201
Entity
Organization
Contact information
Practice address
16535 SW TUALATIN VALLEY HWY, BEAVERTON, OR 97006-5143
(503) 649-5651
(503) 649-7405
Mailing address
16535 SW TUALATIN VALLEY HWY, BEAVERTON, OR 97006-5143
(503) 649-5651
(503) 649-7405
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
OR
103T00000X
Psychologist
891
OR
103TB0200X
Cognitive & Behavioral Psychologist
891
OR
103TC0700X
Clinical Psychologist
891
OR
103TC1900X
Counseling Psychologist
Primary
891
OR
103TC2200X
Clinical Child & Adolescent Psychologist
891
OR
106H00000X
Marriage & Family Therapist
T0433
OR
2084P0804X
Child & Adolescent Psychiatry Physician
17887
OR
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
OR
283Q00000X
Psychiatric Hospital
17887
OR
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210855
—
OR
Enumeration date
10/17/2006
Last updated
05/07/2013
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