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15446 Stephanie Ct Lake Oswego OR 97035-3182 | |
| (503) 479-5474 | |
| (847) 907-0078 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 15446 Stephanie Ct, Lake Oswego, Oregon |
| Authorized Official Name and Position | Eric Jon Bruemmer (OWNER, SENIOR COUNSELOR) |
| Authorized Official Contact | 5034795474 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15446 Stephanie Ct Lake Oswego OR 97035-3182 Ph: (503) 479-5474 | 15446 Stephanie Ct Lake Oswego OR 97035-3182 Ph: (503) 479-5474 |
| NPI Number | 1568853059 |
|---|---|
| Provider Enumeration Date | 02/05/2015 |
| Last Update Date | 01/24/2020 |
| Certification Date | 01/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568853059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 180-006657 (Illinois) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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