Organization
PACIFIC NORTHWEST TELETHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMA MOON LCSW (OWNER)
(503) 383-9225
Entity
Organization
Contact information
Practice address
5441 S MACADAM AVE STE 8054, PORTLAND, OR 97239-6106
(503) 383-9225
Mailing address
5441 S MACADAM AVE STE 8054, PORTLAND, OR 97239-6106
(503) 383-9225
(458) 234-4341
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/24/2024
Last updated
04/08/2026
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