Provider Demographics
NPI:1346895984
Name:HEALTH ALLIES
Entity Type:Organization
Organization Name:HEALTH ALLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC, CADCI
Authorized Official - Phone:971-270-0167
Mailing Address - Street 1:2926 NE FLANDERS ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3259
Mailing Address - Country:US
Mailing Address - Phone:971-270-0167
Mailing Address - Fax:
Practice Address - Street 1:2926 NE FLANDERS ST STE 3C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3259
Practice Address - Country:US
Practice Address - Phone:971-270-0167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health