Provider Demographics
NPI:1336504430
Name:CENTER FOR RELATIONSHIP THERAPY
Entity Type:Organization
Organization Name:CENTER FOR RELATIONSHIP THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-239-3915
Mailing Address - Street 1:8125 SE PINE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1554
Mailing Address - Country:US
Mailing Address - Phone:503-239-3915
Mailing Address - Fax:503-253-0796
Practice Address - Street 1:8125 SE PINE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1554
Practice Address - Country:US
Practice Address - Phone:503-239-3915
Practice Address - Fax:503-253-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO505261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health