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General NPI Number Information
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NPI Number | 1417832296
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Entity Type | Organization
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Legal Business Name | OUTREACH PDX LLC
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Dates
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Enumeration Date | 08/09/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 17518 SE RIVER RD
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City | PORTLAND
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State | OR
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Zip | 97267-5635
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Country | US
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Telephone | 315-532-2887
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Fax |
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Provider Business Mailing Address
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Address Line | 17518 SE RIVER RD
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City | PORTLAND
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State | OR
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Zip | 97267-5635
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | WILLIAM LEE CLARK
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Credential | CRM, CADC-R, THW
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Telephone | 971-990-7628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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