Healthcare Provider Details

I. General information

NPI: 1588116503
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH OF OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SE 151ST AVE
PORTLAND OR
97233-2916
US

IV. Provider business mailing address

805 SE 151ST AVE
PORTLAND OR
97233-2916
US

V. Phone/Fax

Practice location:
  • Phone: 503-312-4781
  • Fax: 971-421-7772
Mailing address:
  • Phone: 503-312-4781
  • Fax: 971-421-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: AMY LUGO
Title or Position: HR COORDINATOR
Credential:
Phone: 503-666-6575