Provider Demographics
NPI:1275387250
Name:ONTIC LLC
Entity Type:Organization
Organization Name:ONTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FINLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC, MA, MS
Authorized Official - Phone:971-203-2043
Mailing Address - Street 1:5 SE M L KING BLVD APT 818
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1193
Mailing Address - Country:US
Mailing Address - Phone:318-419-4900
Mailing Address - Fax:
Practice Address - Street 1:5 SE M L KING BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1161
Practice Address - Country:US
Practice Address - Phone:318-419-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)