Provider Demographics
NPI:1033880091
Name:HOPE AND HEALING TRAUMA CENTER
Entity Type:Organization
Organization Name:HOPE AND HEALING TRAUMA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-243-0414
Mailing Address - Street 1:6975 SW SANDBURG ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8089
Mailing Address - Country:US
Mailing Address - Phone:814-243-0414
Mailing Address - Fax:814-479-8113
Practice Address - Street 1:6975 SW SANDBURG ST STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8089
Practice Address - Country:US
Practice Address - Phone:814-243-0414
Practice Address - Fax:814-479-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty