Organization
RADIANT MIND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNAMARIE HARRISON (ADMINISTRATIVE ASSISTANT)
(503) 386-1972
Entity
Organization
Contact information
Practice address
8638A N LOMBARD ST STE 3, PORTLAND, OR 97203-3741
(503) 386-1972
Mailing address
9707 N CLARENDON AVE, PORTLAND, OR 97203-1917
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
05/18/2022
Last updated
05/18/2022
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