Provider Demographics
NPI:1558638619
Name:SEQUOIA MENTAL HEALTH
Entity Type:Organization
Organization Name:SEQUOIA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SKILLS TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:PARLAN
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:QMHA
Authorized Official - Phone:503-649-4925
Mailing Address - Street 1:4180 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-1564
Mailing Address - Country:US
Mailing Address - Phone:503-649-4925
Mailing Address - Fax:503-591-5602
Practice Address - Street 1:4585 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-1557
Practice Address - Country:US
Practice Address - Phone:503-591-9280
Practice Address - Fax:503-848-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness