| Darelivethrive, Llc | |
|
4730 Sw Macadam Ave Suite 201-g Portland OR 97239-6417 | |
| (818) 370-6423 | |
| Not Available |
| Full Name | Darelivethrive, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4730 Sw Macadam Ave, Portland, Oregon |
| Authorized Official Name and Position | Shane D Kennington (OWNER) |
| Authorized Official Contact | 8183706423 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Darelivethrive, Llc 4730 Sw Macadam Ave Suite 201-g Portland OR 97239-6417 Ph: (818) 370-6423 | Darelivethrive, Llc 4730 Sw Macadam Ave Suite 201-g Portland OR 97239-6417 Ph: (818) 370-6423 |
| NPI Number | 1861940306 |
|---|---|
| Provider Enumeration Date | 09/13/2016 |
| Last Update Date | 09/13/2016 |
| Medicare PECOS PAC ID | 4688962723 |
|---|---|
| Medicare Enrollment ID | O20161005002117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861940306 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shane D Kennington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174754493 PECOS PAC ID: 8527195858 Enrollment ID: I20161005002186 |
Sandra M. Gonzalez Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1130 Sw Morrison St, Suite 411, Portland, OR 97205 Phone: 503-228-0939 Fax: 503-226-8069 | |
Cascadia Behavioral Healthcare, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9125 Sw 55th Ave, Portland, OR 97219 Phone: 503-238-0769 Fax: 503-477-4598 | |
Edwards Psychotherapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1220 Sw Morrison St, Suite 1100, Portland, OR 97205 Phone: 503-222-0557 | |
Wellpath Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3701 Se Milwaukie Ave Ste D, Portland, OR 97202 Phone: 503-784-2377 | |
Daniel C Donohue, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2931 Ne Broadway St, Portland, OR 97232 Phone: 503-819-2515 | |
Cultivating A New Life Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Se Spokane St Ste 300, Portland, OR 97202 Phone: 541-904-0468 | |
Tiffany Kettermann, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2926 Ne Flanders St Ste 3c, Portland, OR 97232 Phone: 971-270-0167 |