Provider Demographics
NPI:1326353277
Name:CHRISTIAN TREATMENT CENTER FOR ATTACHMENT TRAUMA AND SEXUAL ADD LLC
Entity Type:Organization
Organization Name:CHRISTIAN TREATMENT CENTER FOR ATTACHMENT TRAUMA AND SEXUAL ADD LLC
Other - Org Name:THE FOUR RIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LMHC,MA
Authorized Official - Phone:503-680-2478
Mailing Address - Street 1:3731 SE 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1709
Mailing Address - Country:US
Mailing Address - Phone:503-680-2478
Mailing Address - Fax:360-891-5511
Practice Address - Street 1:9101 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1515
Practice Address - Country:US
Practice Address - Phone:503-680-2478
Practice Address - Fax:360-891-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1901251S00000X
WALH00010659251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1336313907OtherNPI # FOR HANNAH FISCHER COUNSELING INC