Healthcare Provider Details

I. General information

NPI: 1902644560
Provider Name (Legal Business Name): PACIFIC SYNERGIES NW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BEAVERCREEK RD STE 102
OREGON CITY OR
97045-4287
US

IV. Provider business mailing address

418 BEAVERCREEK RD STE 102
OREGON CITY OR
97045-4287
US

V. Phone/Fax

Practice location:
  • Phone: 971-203-0683
  • Fax: 503-212-0174
Mailing address:
  • Phone: 971-203-0683
  • Fax: 503-212-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREA REDEAU
Title or Position: CLINIC DIRECTOR
Credential: LPC
Phone: 503-998-5613