Healthcare Provider Details

I. General information

NPI: 1073853966
Provider Name (Legal Business Name): PORTLAND DBT INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S MACADAM AVE., STE 350
PORTLAND OR
97239-3877
US

IV. Provider business mailing address

5100 S MACADAM AVE., STE. 350
PORTLAND OR
97239-3837
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-7854
  • Fax: 503-231-8153
Mailing address:
  • Phone: 503-231-7854
  • Fax: 503-231-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LOREN WAMPLER
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 503-231-7854