Provider Demographics
NPI:1912025461
Name:HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW
Entity Type:Organization
Organization Name:HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, CADCIII
Authorized Official - Phone:503-325-6754
Mailing Address - Street 1:3107 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2729
Mailing Address - Country:US
Mailing Address - Phone:503-325-6754
Mailing Address - Fax:503-325-1088
Practice Address - Street 1:3107 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-2729
Practice Address - Country:US
Practice Address - Phone:503-325-6754
Practice Address - Fax:503-325-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251V00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR578168000OtherMAGELLAN HEALTH SERVICES
OR174029174029OtherLIFEWISE INSURANCE
ORJ4525-01OtherPACIFIC SOURCE INSURANCE
OR089299000OtherREGENCE BLUE CROSS
OR6860-MAOtherPACIFICARE BEHAVIORAL HEA
ORA023OtherTRICARE