Provider Demographics
NPI:1790459964
Name:PARK, YERIM
Entity Type:Individual
Prefix:
First Name:YERIM
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 SW HAMPTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8360
Mailing Address - Country:US
Mailing Address - Phone:503-828-6996
Mailing Address - Fax:
Practice Address - Street 1:6745 SW HAMPTON ST STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8360
Practice Address - Country:US
Practice Address - Phone:503-828-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health