Provider Demographics
NPI:1275123762
Name:SPECTRUM COUNSELING AND MENTAL WELLNESS
Entity Type:Organization
Organization Name:SPECTRUM COUNSELING AND MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:LILYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-373-4497
Mailing Address - Street 1:101 SW MADISON ST UNIT 9152
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3264
Mailing Address - Country:US
Mailing Address - Phone:971-373-4497
Mailing Address - Fax:
Practice Address - Street 1:1220 SW MORRISON ST STE 1201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2231
Practice Address - Country:US
Practice Address - Phone:971-373-4497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty