Provider Demographics
NPI:1558839068
Name:SAPPHIRE BLUE BEHAVIORAL HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:SAPPHIRE BLUE BEHAVIORAL HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:A.
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LA VERNE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC, MAC, CADC
Authorized Official - Phone:503-726-5216
Mailing Address - Street 1:5285 MEADOWS RD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3478
Mailing Address - Country:US
Mailing Address - Phone:503-276-5216
Mailing Address - Fax:
Practice Address - Street 1:5285 MEADOWS RD STE 170
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3478
Practice Address - Country:US
Practice Address - Phone:503-276-5216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty