Healthcare Provider Details

I. General information

NPI: 1477801454
Provider Name (Legal Business Name): NEW HORIZONS WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE. 618
BEAVERTON OR
97005-3019
US

IV. Provider business mailing address

10700 SW BEAVERTON HILLSDALE HWY STE. 618
BEAVERTON OR
97005-3019
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-0240
  • Fax:
Mailing address:
  • Phone: 503-352-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1615
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number986473
License Number StateOR

VIII. Authorized Official

Name: DR. PATRICK E ETHEL-KING
Title or Position: DIRECTOR/PSYCHOLOGIST
Credential: PH.D.
Phone: 503-352-0240