Provider Demographics
NPI:1760558365
Name:WASHINGTON COUNTY HEALTH & HUMAN SERVICES
Entity Type:Organization
Organization Name:WASHINGTON COUNTY HEALTH & HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH PROGRAM SUPERVISO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-846-4552
Mailing Address - Street 1:155 N 1ST AVE
Mailing Address - Street 2:MS70
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3001
Mailing Address - Country:US
Mailing Address - Phone:503-846-4528
Mailing Address - Fax:503-846-4560
Practice Address - Street 1:155 N 1ST AVE
Practice Address - Street 2:MS70
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3001
Practice Address - Country:US
Practice Address - Phone:503-846-4528
Practice Address - Fax:503-846-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR215145Medicaid