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General NPI Number Information
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NPI Number | 1386767176
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Entity Type | Organization
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Legal Business Name | TELECARE MENTAL HEALTH SERVICES OF OREGON, INC.
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 4101 NE DIVISION ST SUITE 100
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City | GRESHAM
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State | OR
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Zip | 97030-4617
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Country | US
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Telephone | 503-666-3808
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Fax | 503-666-6835
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Provider Business Mailing Address
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Address Line | 1080 MARINA VILLAGE PKWY SUITE 100
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City | ALAMEDA
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State | CA
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Zip | 94501-6427
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Country | US
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Telephone | 503-666-6575
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Fax | 503-666-4047
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Authorized Official
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Title or Position | SVP, CFO
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Name | LESLIE DAVIS
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Credential |
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Telephone | 510-337-7950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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