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2115 Se Adams St Ste B Milwaukie OR 97222-7773 | |
| (503) 659-3480 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2115 Se Adams St Ste B, Milwaukie, Oregon |
| Authorized Official Name and Position | Barbara Majors (OWNER) |
| Authorized Official Contact | 5036593480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2115 Se Adams St Ste B Milwaukie OR 97222-7773 Ph: (503) 659-3480 | 2115 Se Adams St Ste B Milwaukie OR 97222-7773 Ph: (503) 659-3480 |
| NPI Number | 1104323245 |
|---|---|
| Provider Enumeration Date | 04/06/2018 |
| Last Update Date | 04/06/2018 |
| Medicare PECOS PAC ID | 6608139498 |
|---|---|
| Medicare Enrollment ID | O20180409001087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104323245 | NPI | - | NPPES |
| 500699670 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | L7412 (Oregon) | Primary |
| Provider Name | Barbara L Majors |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821474081 PECOS PAC ID: 7719246263 Enrollment ID: I20180109002025 |
| Provider Name | Sara Booth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659550937 PECOS PAC ID: 3173859444 Enrollment ID: I20190724001252 |
| Provider Name | Aubrey R Harrington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790410686 PECOS PAC ID: 4385029065 Enrollment ID: I20220915003223 |
| Provider Name | Kevin Christaldi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942735675 PECOS PAC ID: 6103361910 Enrollment ID: I20240716002744 |
| Provider Name | Valerie Garst |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720481633 PECOS PAC ID: 0143765966 Enrollment ID: I20240716002999 |
| Provider Name | Mary Lopez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447664362 PECOS PAC ID: 6406207216 Enrollment ID: I20240716003189 |
| Provider Name | Kelsey A Papadatos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730763996 PECOS PAC ID: 2668917493 Enrollment ID: I20240716003509 |
| Provider Name | Jeremiah L Richardson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588062806 PECOS PAC ID: 3971048752 Enrollment ID: I20240717000481 |
| Provider Name | Sara Dewitt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487859963 PECOS PAC ID: 4880139559 Enrollment ID: I20240717004016 |
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