Healthcare Provider Details

I. General information

NPI: 1851827638
Provider Name (Legal Business Name): NORTHWEST ADHD TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18840 SW BOONES FERRY RD STE 208
TUALATIN OR
97062-9688
US

IV. Provider business mailing address

18840 SW BOONES FERRY RD STE 208
TUALATIN OR
97062-9688
US

V. Phone/Fax

Practice location:
  • Phone: 503-427-2394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LENNEN
Title or Position: PSYCHOLOGIST
Credential:
Phone: 503-255-2343