Provider Demographics
NPI:1588389563
Name:BLACK MEN & WOMEN IN TRAINING
Entity type:Organization
Organization Name:BLACK MEN & WOMEN IN TRAINING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BSHA
Authorized Official - Phone:503-724-3725
Mailing Address - Street 1:5257 NE MLK JR BLVD STE 202E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3283
Mailing Address - Country:US
Mailing Address - Phone:971-342-0117
Mailing Address - Fax:503-296-2937
Practice Address - Street 1:5257 NE MLK JR BLVD STE 202E
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3283
Practice Address - Country:US
Practice Address - Phone:971-342-0117
Practice Address - Fax:503-296-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty