Provider Demographics
NPI:1215574058
Name:NORTHWEST DBT LLC
Entity Type:Organization
Organization Name:NORTHWEST DBT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JENDRITZA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-963-6540
Mailing Address - Street 1:2230 NW PETTYGROVE ST.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-963-6540
Mailing Address - Fax:888-965-8362
Practice Address - Street 1:2230 NW PETTYGROVE ST.
Practice Address - Street 2:SUITE 130
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-963-6540
Practice Address - Fax:888-965-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty