Provider Demographics
NPI:1023866878
Name:4D TREATMENT MENTOR SERVICES
Entity type:Organization
Organization Name:4D TREATMENT MENTOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:MATHIAS THOMAS
Authorized Official - Last Name:CRAPSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LMHC
Authorized Official - Phone:971-422-0044
Mailing Address - Street 1:11010 SE DIVISION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6400
Mailing Address - Country:US
Mailing Address - Phone:971-422-0044
Mailing Address - Fax:
Practice Address - Street 1:11010 SE DIVISION ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6400
Practice Address - Country:US
Practice Address - Phone:971-422-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:4TH DIMENSION RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty