Healthcare Provider Details

I. General information

NPI: 1669172656
Provider Name (Legal Business Name): HART-2-HEART THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN AVE STE 201A
GRESHAM OR
97030-7242
US

IV. Provider business mailing address

2870 NE HOGAN DR STE. E, #140
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-610-3615
  • Fax:
Mailing address:
  • Phone: 503-610-3615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. GRANT HART
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 503-610-3615