| Providence Consulting Psychiatry East | |
|
4805 Ne Glisan St 3e Portland OR 97213-2933 | |
| (503) 216-2028 | |
| (503) 216-2485 |
| Full Name | Providence Consulting Psychiatry East |
|---|---|
| Speciality | Clinic/center |
| Location | 4805 Ne Glisan St, Portland, Oregon |
| Authorized Official Name and Position | Mitchell Neyhart (CFO) |
| Authorized Official Contact | 5035749840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Consulting Psychiatry East Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Consulting Psychiatry East 4805 Ne Glisan St 3e Portland OR 97213-2933 Ph: (503) 216-2028 |
| NPI Number | 1316038631 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 04/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316038631 | NPI | - | NPPES |
| 213554 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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