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General NPI Number Information
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NPI Number | 1477737575
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Entity Type | Individual
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Provider Name | GRANT DONNELL PARTRIDGE M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 06/15/2024
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Provider Practice Location Address
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Address Line | 4424 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97213-2331
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Country | US
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Telephone | 503-455-4016
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17005
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City | PORTLAND
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State | OR
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Zip | 97217-0005
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Country | US
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Telephone | 503-455-4016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF60771144
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 53307
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T1137
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License Number State | OR
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