Provider Demographics
NPI:1689812166
Name:LIFEWORKS NORTHWEST
Entity Type:Organization
Organization Name:LIFEWORKS NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONNAT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CADCIII
Authorized Official - Phone:503-645-3581
Mailing Address - Street 1:5415 SW WESTGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2406
Mailing Address - Country:US
Mailing Address - Phone:503-645-3581
Mailing Address - Fax:503-629-8517
Practice Address - Street 1:5415 SW WESTGATE DRIVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2406
Practice Address - Country:US
Practice Address - Phone:503-645-3581
Practice Address - Fax:503-629-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR206763Medicaid