Provider Demographics
NPI:1588862643
Name:MARTHA JAMES
Entity type:Organization
Organization Name:MARTHA JAMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-933-2837
Mailing Address - Street 1:5052 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1550
Mailing Address - Country:US
Mailing Address - Phone:503-933-2837
Mailing Address - Fax:
Practice Address - Street 1:5052 NE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1550
Practice Address - Country:US
Practice Address - Phone:503-933-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREATMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5536251K00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No251K00000XAgenciesPublic Health or Welfare