1093126674 NPI number — TRANSITIONS PROFESSIONAL CENTER

Table of content: (NPI 1093126674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093126674 NPI number — TRANSITIONS PROFESSIONAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSITIONS PROFESSIONAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093126674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4207 SE WOODSTOCK BLVD # 411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97206-6267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-972-7090
Provider Business Mailing Address Fax Number:
833-527-3447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6514 SE 42ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97206-7702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-972-7090
Provider Business Practice Location Address Fax Number:
833-527-3447
Provider Enumeration Date:
05/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VIERCK
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
503-972-7090

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2439 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2439 . This is a "OREGON BOARD OF PSYCHOLOGIST EXAMINERS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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