Organization
HOLLY WIGMORE LLC
Active
Parent organization
HOLLY WIGMORE LLC
Other names
Holly Wigmore
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOLLY WIGMORE LLC
Authorized official
MS. HOLLY WIGMORE LPC (PRACTICE OWNER)
(503) 843-8862
Entity
Organization
Contact information
Practice address
5901 S MACADAM AVE STE 100, PORTLAND, OR 97239-3620
(503) 843-8862
Mailing address
1110 SE ALDER ST STE 301, PORTLAND, OR 97214-2400
(503) 843-8862
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
01/10/2025
Last updated
01/10/2025
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