Provider Demographics
NPI:1093126674
Name:TRANSITIONS PROFESSIONAL CENTER
Entity Type:Organization
Organization Name:TRANSITIONS PROFESSIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIERCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-972-7090
Mailing Address - Street 1:4207 SE WOODSTOCK BLVD # 411
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6267
Mailing Address - Country:US
Mailing Address - Phone:503-972-7090
Mailing Address - Fax:833-527-3447
Practice Address - Street 1:6514 SE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-7702
Practice Address - Country:US
Practice Address - Phone:503-972-7090
Practice Address - Fax:833-527-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2439103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2439OtherOREGON BOARD OF PSYCHOLOGIST EXAMINERS