Owls Nest North Therapy Joint | |
3615 Ne Grand Ave Portland OR 97212-2104 | |
(503) 281-1166 | |
(503) 281-0787 |
Full Name | Owls Nest North Therapy Joint |
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Speciality | Marriage & Family Therapist |
Location | 3615 Ne Grand Ave, Portland, Oregon |
Authorized Official Name and Position | Kristi Erlich (OWNER) |
Authorized Official Contact | 5032811166 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Owls Nest North Therapy Joint 3615 Ne Grand Ave Portland OR 97212-2104 Ph: () - | Owls Nest North Therapy Joint 3615 Ne Grand Ave Portland OR 97212-2104 Ph: (503) 281-1166 |
NPI Number | 1376948232 |
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Provider Enumeration Date | 11/04/2014 |
Last Update Date | 03/06/2024 |
Certification Date | 03/06/2024 |
Medicare PECOS PAC ID | 0840734943 |
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Medicare Enrollment ID | O20240701000735 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376948232 | NPI | - | NPPES |
500643178 MCD | Medicaid | OR |
Provider Name | Kristine Erlich |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1740506716 PECOS PAC ID: 1759825854 Enrollment ID: I20240703000784 |
Provider Name | Heather Mary Sutch |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1902921935 PECOS PAC ID: 4587100763 Enrollment ID: I20240724001387 |
Provider Name | Sophe Luna Jones |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1053869248 PECOS PAC ID: 9436697828 Enrollment ID: I20240816000439 |
Provider Name | Scout Viola Northway |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1073275079 PECOS PAC ID: 0446799399 Enrollment ID: I20240823001551 |
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