Provider Demographics
NPI:1073853966
Name:PORTLAND DBT INSTITUTE, INC.
Entity Type:Organization
Organization Name:PORTLAND DBT INSTITUTE, INC.
Other - Org Name:PORTLAND DBT INSTITUTE OF SALEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-231-7854
Mailing Address - Street 1:5100 S MACADAM AVE., STE. 350
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3837
Mailing Address - Country:US
Mailing Address - Phone:503-231-7854
Mailing Address - Fax:503-231-8153
Practice Address - Street 1:5100 S MACADAM AVE., STE 350
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3877
Practice Address - Country:US
Practice Address - Phone:503-231-7854
Practice Address - Fax:503-231-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty