Provider Demographics
NPI:1750127429
Name:R.E.A.P.
Entity type:Organization
Organization Name:R.E.A.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:DESHAWN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:503-334-9955
Mailing Address - Street 1:10808 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3047
Mailing Address - Country:US
Mailing Address - Phone:503-688-2784
Mailing Address - Fax:971-302-6649
Practice Address - Street 1:10814 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3047
Practice Address - Country:US
Practice Address - Phone:503-688-2784
Practice Address - Fax:971-302-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health