Healthcare Provider Details

I. General information

NPI: 1851204135
Provider Name (Legal Business Name): ETANSA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13095 SE SNOWFIRE DR
HAPPY VALLEY OR
97086-8021
US

IV. Provider business mailing address

12161 SE JOHANSEN CT
CLACKAMAS OR
97015-7226
US

V. Phone/Fax

Practice location:
  • Phone: 214-586-9800
  • Fax:
Mailing address:
  • Phone: 214-586-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EYUEL ETANSA
Title or Position: DIRECTOR
Credential:
Phone: 214-586-9800