Provider Demographics
NPI:1235164559
Name:SAMARITAN COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:503-281-3318
Mailing Address - Street 1:1205 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1233
Mailing Address - Country:US
Mailing Address - Phone:503-281-3318
Mailing Address - Fax:503-281-0937
Practice Address - Street 1:1205 NE BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-281-3318
Practice Address - Fax:503-281-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR048465000OtherBCBS
OR271177Medicaid
OR271177Medicaid