Healthcare Provider Details

I. General information

NPI: 1366989485
Provider Name (Legal Business Name): MICHELLE HASSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4548 SW 191ST AVE
ALOHA OR
97078-2425
US

IV. Provider business mailing address

4548 SW 191ST AVE
ALOHA OR
97078-2425
US

V. Phone/Fax

Practice location:
  • Phone: 503-848-5768
  • Fax: 503-848-9641
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number500601014
License Number StateOR

VIII. Authorized Official

Name: MICHELLE HASSON
Title or Position: OWNER
Credential:
Phone: 503-523-9809