Basic Information
| Provider Information | |||||||||
| NPI: | 1558638619 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEQUOIA MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4180 SW 185TH AVE | ||||||||
| Address2: | |||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970071564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036494925 | ||||||||
| FaxNumber: | 5035915602 | ||||||||
| Practice Location | |||||||||
| Address1: | 4585 SW 185TH AVE | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970071557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035919280 | ||||||||
| FaxNumber: | 5038482072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2011 | ||||||||
| LastUpdateDate: | 11/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | BETTS | ||||||||
| AuthorizedOfficialFirstName: | PARLAN | ||||||||
| AuthorizedOfficialMiddleName: | MALCOLM | ||||||||
| AuthorizedOfficialTitleorPosition: | SKILLS TRAINER | ||||||||
| AuthorizedOfficialTelephone: | 5036494925 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | QMHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | NONE | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.