Provider Demographics
NPI:1245306711
Name:BEHAVIORAL HEALTHCARE NORTHWEST PC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTHCARE NORTHWEST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HURLEY
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-252-9690
Mailing Address - Street 1:10000 SE MAIN ST
Mailing Address - Street 2:STE 215
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2442
Mailing Address - Country:US
Mailing Address - Phone:503-252-9690
Mailing Address - Fax:503-252-2720
Practice Address - Street 1:10000 SE MAIN ST
Practice Address - Street 2:STE 215
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2442
Practice Address - Country:US
Practice Address - Phone:503-252-9690
Practice Address - Fax:503-252-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty