Provider Demographics
NPI:1922708783
Name:ELLHORN, LLC
Entity Type:Organization
Organization Name:ELLHORN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, CRC, PCA
Authorized Official - Phone:503-447-3566
Mailing Address - Street 1:PO BOX 2131
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-2131
Mailing Address - Country:US
Mailing Address - Phone:503-447-3566
Mailing Address - Fax:
Practice Address - Street 1:14800 SW CARLSBAD DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-5924
Practice Address - Country:US
Practice Address - Phone:503-447-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty