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General NPI Number Information
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NPI Number | 1790475960
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Entity Type | Organization
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Legal Business Name | DEEP WITHIN THERAPY, LLC
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 172 NE 32ND AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-6736
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Country | US
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Telephone | 503-454-6243
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Fax |
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Provider Business Mailing Address
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Address Line | 7325 NE IMBRIE DR # 224
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City | HILLSBORO
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State | OR
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Zip | 97124-7595
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Country | US
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Telephone | 503-454-6243
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/MANAGER
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Name | BABETTE REEVES
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Credential | LCSW
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Telephone | 503-454-6243
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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 |
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License Number State |
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