Provider Demographics
NPI:1972639458
Name:STRAIGHT FROM THE HEART
Entity type:Organization
Organization Name:STRAIGHT FROM THE HEART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF STRAIGHT FROM THE HEAR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:STRETCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-232-0969
Mailing Address - Street 1:5404 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4557
Mailing Address - Country:US
Mailing Address - Phone:503-232-0969
Mailing Address - Fax:503-234-2326
Practice Address - Street 1:5404 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4557
Practice Address - Country:US
Practice Address - Phone:503-232-0969
Practice Address - Fax:503-234-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORALICE RICHARD LIC# 11041C0700X
ORPAUL STRETCH #19941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty