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General NPI Number Information
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NPI Number | 1457763443
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Entity Type | Organization
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Legal Business Name | NORTHWEST FAMILY MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 1675 SW MARLOW AVE SUITE 303
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City | PORTLAND
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State | OR
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Zip | 97225-5104
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Country | US
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Telephone | 503-601-3770
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Fax | 503-601-3775
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Provider Business Mailing Address
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Address Line | 1675 SW MARLOW AVE SUITE 303
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City | PORTLAND
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State | OR
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Zip | 97225-5104
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Country | US
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Telephone | 503-601-3770
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Fax | 503-601-3775
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Authorized Official
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Title or Position | MSW, OWNER
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Name | CHRISTINA MICHELLE TINGLEY
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Credential | MSW
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Telephone | 503-601-3770
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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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