Organization
POLK COUNTY MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERGIO GUTIERREZ (MENTAL HEALTH COUNSELOR I)
(503) 623-9289
Entity
Organization
Contact information
Practice address
182 SW ACADEMY ST STE 304, DALLAS, OR 97338-1900
(503) 623-9289
(503) 831-1726
Mailing address
182 SW ACADEMY ST STE 304, DALLAS, OR 97338-1900
(503) 851-6737
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
00-07-15
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-07-15
CADC I
OR
Enumeration date
03/29/2007
Last updated
07/02/2008
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