Healthcare Provider Details

I. General information

NPI: 1619913787
Provider Name (Legal Business Name): PORTLAND DIALECTICAL BEHAVIOR THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 SW MACADAM AVE STE 580
PORTLAND OR
97239
US

IV. Provider business mailing address

5200 SW MACADAM AVE STE 580
PORTLAND OR
97239
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: AMBERLY MARTINSON
Title or Position: OFFICE MANAGER
Credential: BS
Phone: 503-231-7854