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General NPI Number Information
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NPI Number | 1285989822
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Entity Type | Organization
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Legal Business Name | MIDSTREAM
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 1020 SW TAYLOR ST SUITE 400
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City | PORTLAND
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State | OR
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Zip | 97205-2543
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Country | US
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Telephone | 503-715-0910
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Fax | 503-715-0911
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Provider Business Mailing Address
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Address Line | 1020 SW TAYLOR ST SUITE 400
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City | PORTLAND
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State | OR
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Zip | 97205-2543
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Country | US
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Telephone | 503-715-0910
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Fax | 503-715-0911
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TARA CROWLEY
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Credential | LCSW
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Telephone | 503-715-0910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L5721
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License Number State | OR
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