Provider Demographics
NPI:1922405745
Name:TRANSACTIVE GENDER CENTER
Entity Type:Organization
Organization Name:TRANSACTIVE GENDER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICES PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-252-3000
Mailing Address - Street 1:1631 NE BROADWAY ST # 355-T
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1425
Mailing Address - Country:US
Mailing Address - Phone:503-252-3000
Mailing Address - Fax:503-255-3367
Practice Address - Street 1:1441 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1270
Practice Address - Country:US
Practice Address - Phone:503-252-3000
Practice Address - Fax:503-255-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty