Provider Demographics
NPI:1124583786
Name:ABRI RADICALLY OPEN DBT LLC
Entity Type:Organization
Organization Name:ABRI RADICALLY OPEN DBT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LI LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-267-4786
Mailing Address - Street 1:520 SW YAMHILL ST STE 345
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1335
Mailing Address - Country:US
Mailing Address - Phone:503-267-4786
Mailing Address - Fax:
Practice Address - Street 1:520 SW YAMHILL ST STE 345
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1335
Practice Address - Country:US
Practice Address - Phone:503-267-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty