Provider Demographics
NPI:1194037283
Name:DE PAUL TREATMENT CENTERS
Entity Type:Organization
Organization Name:DE PAUL TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:503-535-1174
Mailing Address - Street 1:1312 SW WASHINGTON
Mailing Address - Street 2:P.O. BOX 3007
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1312 SW WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97208
Practice Address - Country:US
Practice Address - Phone:503-535-1181
Practice Address - Fax:503-535-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0680324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility