Provider Demographics
NPI:1457763443
Name:NORTHWEST FAMILY MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:NORTHWEST FAMILY MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:TINGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:503-601-3770
Mailing Address - Street 1:1675 SW MARLOW AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5104
Mailing Address - Country:US
Mailing Address - Phone:503-601-3770
Mailing Address - Fax:503-601-3775
Practice Address - Street 1:1675 SW MARLOW AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5104
Practice Address - Country:US
Practice Address - Phone:503-601-3770
Practice Address - Fax:503-601-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health