| The Lighter Heart, Pc | |
|
1732 Se Ash St Portland OR 97214-1526 | |
| (503) 249-7844 | |
| (503) 715-5761 |
| Full Name | The Lighter Heart, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 1732 Se Ash St, Portland, Oregon |
| Authorized Official Name and Position | Steven Kelly O'dell (OWNER) |
| Authorized Official Contact | 5032497844 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Lighter Heart, Pc 1732 Se Ash St Portland OR 97214-1526 Ph: (503) 249-7844 | The Lighter Heart, Pc 1732 Se Ash St Portland OR 97214-1526 Ph: (503) 249-7844 |
| NPI Number | 1942532650 |
|---|---|
| Provider Enumeration Date | 02/04/2010 |
| Last Update Date | 02/04/2010 |
| Medicare PECOS PAC ID | 0840326757 |
|---|---|
| Medicare Enrollment ID | O20100330001160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942532650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2226 (Oregon) | Primary |
| Provider Name | Steven K Odell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548244809 PECOS PAC ID: 3779619689 Enrollment ID: I20100330001142 |
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