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1110 Se Alder St. Ste 301 Mb #122 Portland OR 97214-2400 | |
| (909) 285-4950 | |
| (909) 285-0564 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1110 Se Alder St. Ste 301, Portland, Oregon |
| Authorized Official Name and Position | Nicole Marie Falk (OWNER) |
| Authorized Official Contact | 9092854950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1110 Se Alder St. Ste 301 Mb #122 Portland OR 97214-2400 Ph: (909) 285-4950 | 1110 Se Alder St. Ste 301 Mb #122 Portland OR 97214-2400 Ph: (909) 285-4950 |
| NPI Number | 1265281000 |
|---|---|
| Provider Enumeration Date | 05/15/2024 |
| Last Update Date | 07/16/2024 |
| Certification Date | 07/16/2024 |
| Medicare PECOS PAC ID | 8628513439 |
|---|---|
| Medicare Enrollment ID | O20240716002448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265281000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Nicole Marie Falk |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366747636 PECOS PAC ID: 6800331612 Enrollment ID: I20240722003263 |
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