Provider Demographics
NPI:1588238042
Name:GARRICK DUCKLER, LLC
Entity Type:Organization
Organization Name:GARRICK DUCKLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-706-9745
Mailing Address - Street 1:2279 NW IRVING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3222
Mailing Address - Country:US
Mailing Address - Phone:415-706-9745
Mailing Address - Fax:
Practice Address - Street 1:2279 NW IRVING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3222
Practice Address - Country:US
Practice Address - Phone:415-706-9745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health