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General NPI Number Information
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NPI Number | 1972044790
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Entity Type | Organization
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Legal Business Name | BUILDING RESILIENCY LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 510 NE ROBERTS AVE STE 310
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City | GRESHAM
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State | OR
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Zip | 97030-7485
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Country | US
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Telephone | 503-997-8863
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Fax |
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Provider Business Mailing Address
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Address Line | 2129 SE 176TH AVE
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City | PORTLAND
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State | OR
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Zip | 97233-5203
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Country | US
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Telephone | 503-997-8863
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Fax |
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Authorized Official
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Title or Position | REGISTERED LPC INTERN
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Name | DESIREE DAWN STANG
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Credential | MA, CADC I, CCTP
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Telephone | 503-997-8863
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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 | R4360
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License Number State | OR
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