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General NPI Number Information
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NPI Number | 1194268748
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Entity Type | Organization
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Legal Business Name | ADVANCED RECOVERY TMS LLC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 2340 NW THURMAN ST SUITE 202
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City | PORTLAND
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State | OR
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Zip | 97210-2579
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Country | US
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Telephone | 503-610-6563
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Fax | 503-227-8058
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Provider Business Mailing Address
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Address Line | 2340 NW THURMAN ST SUITE 202
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City | PORTLAND
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State | OR
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Zip | 97210-2579
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Country | US
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Telephone | 503-610-6563
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Fax | 503-227-8058
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. JONATHAN THOMAS HOREY
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Credential | MD
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Telephone | 503-610-6563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 164194
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License Number State | OR
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