Healthcare Provider Details

I. General information

NPI: 1780135277
Provider Name (Legal Business Name): 360 COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 SW 70TH AVE
TIGARD OR
97223-9634
US

IV. Provider business mailing address

12005 SW 70TH
TIGARD OR
97223
US

V. Phone/Fax

Practice location:
  • Phone: 503-467-9794
  • Fax:
Mailing address:
  • Phone: 503-467-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number677013
License Number StateOR

VIII. Authorized Official

Name: RICHARD POWELL
Title or Position: OWNER
Credential: OT/L
Phone: 503-467-9794