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General NPI Number Information
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NPI Number | 1760971824
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Entity Type | Organization
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Legal Business Name | BRAVE ACORN
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 08/18/2020
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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
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Country | US
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Telephone | 503-709-5137
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Fax | 503-200-1198
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Provider Business Mailing Address
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Address Line | 1675 SW MARLOW AVE STE 303
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City | PORTLAND
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State | OR
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Zip | 97225-5102
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Country | US
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Telephone | 503-709-5137
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH C ALEXANDER
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Credential | LCSW
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Telephone | 503-709-5137
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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 | 4301
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License Number State | OR
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