Provider Demographics
NPI:1083108658
Name:FIRTH, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:FIRTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21427 SW 90TH CT
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8909
Mailing Address - Country:US
Mailing Address - Phone:801-244-0211
Mailing Address - Fax:
Practice Address - Street 1:6011 NE OREGON ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4300
Practice Address - Country:US
Practice Address - Phone:971-256-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL132691041C0700X
UT11098475-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical