Healthcare Provider Details

I. General information

NPI: 1972044790
Provider Name (Legal Business Name): BUILDING RESILIENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NE ROBERTS AVE STE 310
GRESHAM OR
97030-7485
US

IV. Provider business mailing address

2129 SE 176TH AVE
PORTLAND OR
97233-5203
US

V. Phone/Fax

Practice location:
  • Phone: 503-997-8863
  • Fax:
Mailing address:
  • Phone: 503-997-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR4360
License Number StateOR

VIII. Authorized Official

Name: DESIREE DAWN STANG
Title or Position: REGISTERED LPC INTERN
Credential: MA, CADC I, CCTP
Phone: 503-997-8863