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General NPI Number Information
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NPI Number | 1275123762
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Entity Type | Organization
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Legal Business Name | SPECTRUM COUNSELING AND MENTAL WELLNESS
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 1220 SW MORRISON ST STE 1201
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City | PORTLAND
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State | OR
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Zip | 97205-2231
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Country | US
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Telephone | 971-373-4497
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SW MADISON ST UNIT 9152
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City | PORTLAND
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State | OR
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Zip | 97204-3264
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Country | US
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Telephone | 971-373-4497
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Fax |
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Authorized Official
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Title or Position | CHAIR
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Name | LILYAN SMITH-MOORE
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Credential |
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Telephone | 971-373-4497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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