| Sovalti Llc | |
|
12505 Ne Halsey St Portland OR 97230-1928 | |
| (971) 279-7439 | |
| (503) 774-4167 |
| Full Name | Sovalti Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 12505 Ne Halsey St, Portland, Oregon |
| Authorized Official Name and Position | Timisha K Wilson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9712797439 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sovalti Llc Po Box 12765 Portland OR 97212-0765 Ph: () - | Sovalti Llc 12505 Ne Halsey St Portland OR 97230-1928 Ph: (971) 279-7439 |
| NPI Number | 1710445218 |
|---|---|
| Provider Enumeration Date | 03/04/2019 |
| Last Update Date | 04/15/2020 |
| Certification Date | 04/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710445218 | NPI | - | NPPES |
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