Basic Information
| Provider Information | |||||||||
| NPI: | 1225459548 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST ADHD TREATMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16308 | ||||||||
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| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972920308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712315145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10011 SE DIVISION ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032552343 | ||||||||
| FaxNumber: | 5032552344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2014 | ||||||||
| LastUpdateDate: | 04/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | BJORNSON | ||||||||
| AuthorizedOfficialFirstName: | DANELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9715334184 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PMHNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2197 | OR | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 363LP0808X | 201150043NP | OR | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.