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General NPI Number Information
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NPI Number | 1902674534
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Entity Type | Organization
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Legal Business Name | PDX-THERAPY, LLC
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 1020 SW TAYLOR ST STE 765
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City | PORTLAND
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State | OR
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Zip | 97205-2543
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Country | US
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Telephone | 503-512-9198
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 SW HILLSIDE DR
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City | PORTLAND
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State | OR
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Zip | 97221-4108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE CAVESE
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Credential | PSYD, LPC
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Telephone | 503-512-9198
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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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