Provider Demographics
NPI:1902412166
Name:PETER H ADDY LLC
Entity Type:Organization
Organization Name:PETER H ADDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:ADDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:971-336-4956
Mailing Address - Street 1:6118 SE BELMONT ST STE 403
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1983
Mailing Address - Country:US
Mailing Address - Phone:971-336-4956
Mailing Address - Fax:971-200-2427
Practice Address - Street 1:6118 SE BELMONT ST STE 403
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1983
Practice Address - Country:US
Practice Address - Phone:971-336-4956
Practice Address - Fax:971-200-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty