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General NPI Number Information
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NPI Number | 1891150983
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Entity Type | Organization
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Legal Business Name | PACIFIC BIPOLAR TREATMENT PROGRAM
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 1675 SW MARLOW AVE SUITE 305
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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 | 503-646-4664
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Fax | 503-521-7041
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Provider Business Mailing Address
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Address Line | 1675 SW MARLOW AVE SUITE 305
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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 | 503-646-4664
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Fax | 503-521-7041
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Authorized Official
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Title or Position | OWNER
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Name | SHELLY B GETZLAF
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Credential | PHD
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Telephone | 503-646-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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