Basic Information
| Provider Information | |||||||||
| NPI: | 1174738686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST TREATMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970451830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036551029 | ||||||||
| FaxNumber: | 5036554705 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970451830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036551029 | ||||||||
| FaxNumber: | 5036554705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | MACKLIN | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5036551029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 03040 | OR | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.