Provider Demographics
NPI:1821898768
Name:THE ESTUARY CENTER
Entity type:Organization
Organization Name:THE ESTUARY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-804-0276
Mailing Address - Street 1:11865 SW TUALATIN RD
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7081
Mailing Address - Country:US
Mailing Address - Phone:515-460-1650
Mailing Address - Fax:
Practice Address - Street 1:7475 SW OLESON RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-7474
Practice Address - Country:US
Practice Address - Phone:971-804-0276
Practice Address - Fax:503-296-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty