Provider Demographics
NPI:1609399872
Name:HILLSBORO FAMILY BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:HILLSBORO FAMILY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENYSE
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-459-8943
Mailing Address - Street 1:1623 RANKIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3863
Mailing Address - Country:US
Mailing Address - Phone:503-459-8943
Mailing Address - Fax:
Practice Address - Street 1:34575 SE DOYLE RD
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9572
Practice Address - Country:US
Practice Address - Phone:503-459-8943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201600869NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500703987Medicaid