Healthcare Provider Details

I. General information

NPI: 1508033994
Provider Name (Legal Business Name): NORTHWEST INTEGRATIVE HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MERIDIAN ST STE B
NEWBERG OR
97132-2752
US

IV. Provider business mailing address

201 N MERIDIAN ST STE B
NEWBERG OR
97132-2752
US

V. Phone/Fax

Practice location:
  • Phone: 503-476-3182
  • Fax:
Mailing address:
  • Phone: 503-476-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1539
License Number StateOR

VIII. Authorized Official

Name: DR. TIMOTHY P HYATT
Title or Position: OWNER/OPERATOR
Credential: N.D.
Phone: 503-476-3182