Healthcare Provider Details

I. General information

NPI: 1164891180
Provider Name (Legal Business Name): RECOVERY PARTNERS, P.C. AT SPRINGBROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ESTHER ST
NEWBERG OR
97132-9529
US

IV. Provider business mailing address

1901 ESTHER ST
NEWBERG OR
97132-9529
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-4375
  • Fax:
Mailing address:
  • Phone: 503-554-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARVIN SEPPALA
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 651-213-4825