Individual
FLORENCE MUTIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5123 SW 62ND AVE, PORTLAND, OR 97221-1170
(503) 453-2290
Mailing address
5123 SW 62ND AVE, PORTLAND, OR 97221-1170
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/05/2014
Last updated
10/05/2014
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