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General NPI Number Information
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NPI Number | 1801615828
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Entity Type | Organization
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Legal Business Name | RIVERWOOD PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 3439 SE HAWTHORNE BLVD # 947
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City | PORTLAND
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State | OR
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Zip | 97214-5048
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Country | US
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Telephone | 971-460-1676
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Fax |
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Provider Business Mailing Address
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Address Line | 3439 SE HAWTHORNE BLVD # 947
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City | PORTLAND
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State | OR
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Zip | 97214-5048
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Country | US
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Telephone | 971-460-1676
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | JAMES BOYDA
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Credential | LPC
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Telephone | 971-460-1676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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