Provider Demographics
NPI:1760754493
Name:SPRINGWATER THERAPY, LLC
Entity Type:Organization
Organization Name:SPRINGWATER THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:COFFIN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-690-0306
Mailing Address - Street 1:PO BOX 82034
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0034
Mailing Address - Country:US
Mailing Address - Phone:503-690-0306
Mailing Address - Fax:503-967-7066
Practice Address - Street 1:1324 SE SPOKANE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6634
Practice Address - Country:US
Practice Address - Phone:503-690-0306
Practice Address - Fax:503-967-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1280251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1457372096OtherINDIVIDUAL NPI