Healthcare Provider Details

I. General information

NPI: 1326482563
Provider Name (Legal Business Name): FIREFLY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 NE BELKNAP CT SUITE 205
HILLSBORO OR
97124-5113
US

IV. Provider business mailing address

4950 NE BELKNAP CT STE 205
HILLSBORO OR
97124-5115
US

V. Phone/Fax

Practice location:
  • Phone: 503-560-5822
  • Fax: 888-503-2864
Mailing address:
  • Phone: 503-560-5822
  • Fax: 888-503-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberL5487
License Number StateOR

VIII. Authorized Official

Name: MICHELLE MARIE PLISKE
Title or Position: CEO
Credential: MSW LCSW RPT
Phone: 503-560-5822