Provider Demographics
NPI:1942619655
Name:PORTLAND RELATIONSHIP INSTITUTE
Entity Type:Organization
Organization Name:PORTLAND RELATIONSHIP INSTITUTE
Other - Org Name:COUNSELING SERVICES OF PORTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCULLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-342-2510
Mailing Address - Street 1:7100 SW HAMPTON ST
Mailing Address - Street 2:SUITE 223
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-342-2510
Mailing Address - Fax:503-406-2637
Practice Address - Street 1:7100 SW HAMPTON ST
Practice Address - Street 2:SUITE 223
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-342-2510
Practice Address - Fax:503-406-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty