1316221880 NPI number — THE GROTTO COUNSELING CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316221880 NPI number — THE GROTTO COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GROTTO COUNSELING 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:
1316221880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8840 NE SKIDMORE ST
Provider Second Line Business Mailing Address:
PO BOX 20008
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97220-5028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-261-2425
Provider Business Mailing Address Fax Number:
503-254-7948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8840 NE SKIDMORE ST
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:
97220-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-261-2425
Provider Business Practice Location Address Fax Number:
503-254-7948
Provider Enumeration Date:
10/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TERHUNE
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSSINESS MANAGER
Authorized Official Telephone Number:
503-254-7371

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  3903 , 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)