Provider Demographics
NPI:1073146353
Name:ALL TRIBES MENTAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:ALL TRIBES MENTAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CHITWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-205-9722
Mailing Address - Street 1:221 NW 2ND AVE STE 203B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3982
Mailing Address - Country:US
Mailing Address - Phone:541-366-8225
Mailing Address - Fax:
Practice Address - Street 1:221 NW 2ND AVE STE 203B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3982
Practice Address - Country:US
Practice Address - Phone:541-366-8225
Practice Address - Fax:877-775-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500778289Medicaid
OR500740695Medicaid