| Redwood Collaborative, Llc | |
|
1635 N Willamette Blvd Portland OR 97217-3758 | |
| (503) 897-8893 | |
| (503) 447-8713 |
| Full Name | Redwood Collaborative, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1635 N Willamette Blvd, Portland, Oregon |
| Authorized Official Name and Position | Sundaura V Lithman (LLC MEMBER AND CO-FOUNDER) |
| Authorized Official Contact | 5038978893 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Redwood Collaborative, Llc 1635 N Willamette Blvd Portland OR 97217-3758 Ph: () - | Redwood Collaborative, Llc 1635 N Willamette Blvd Portland OR 97217-3758 Ph: (503) 897-8893 |
| NPI Number | 1477252716 |
|---|---|
| Provider Enumeration Date | 02/27/2023 |
| Last Update Date | 02/27/2023 |
| Certification Date | 02/25/2023 |
| Medicare PECOS PAC ID | 0648624015 |
|---|---|
| Medicare Enrollment ID | O20231004000783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477252716 | NPI | - | NPPES |
| Provider Name | Lusijah Marx |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780726976 PECOS PAC ID: 7517854573 Enrollment ID: I20040429000204 |
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