Provider Demographics
NPI:1942951405
Name:BLACK THERAPIST & COMPANY, LLC
Entity Type:Organization
Organization Name:BLACK THERAPIST & COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:503-628-9452
Mailing Address - Street 1:6107 SW MURRAY BLVD # 310
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4421
Mailing Address - Country:US
Mailing Address - Phone:503-628-9452
Mailing Address - Fax:503-356-3087
Practice Address - Street 1:10700 SW BEAVERTON HILLSIDALE HWY
Practice Address - Street 2:BLDG #3, SUITE # 560
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-628-9452
Practice Address - Fax:503-356-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235431214OtherINDIVIDUAL NPI#