Provider Demographics
NPI:1255859583
Name:BRETT STITHEM, LCSW
Entity Type:Organization
Organization Name:BRETT STITHEM, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST IN PRIVATE PRACTICE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:STITHEM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-575-8152
Mailing Address - Street 1:700 SE CESAR E CHAVEZ BLVD APT 315
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3599
Mailing Address - Country:US
Mailing Address - Phone:773-575-8152
Mailing Address - Fax:833-288-5249
Practice Address - Street 1:1312 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1424
Practice Address - Country:US
Practice Address - Phone:773-575-8152
Practice Address - Fax:833-228-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL7183251S00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health