Provider Demographics
NPI:1104145655
Name:DE PAUL DRUG AND ALCOHOL TREATMENT CENTER
Entity type:Organization
Organization Name:DE PAUL DRUG AND ALCOHOL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROFFESIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:503-353-1174
Mailing Address - Street 1:1312 SW WASHINGTON ST
Mailing Address - Street 2:P.O. BOX 3007
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2327
Mailing Address - Country:US
Mailing Address - Phone:503-535-1174
Mailing Address - Fax:503-535-1191
Practice Address - Street 1:1312 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2327
Practice Address - Country:US
Practice Address - Phone:503-535-1174
Practice Address - Fax:503-535-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility