Individual provider · Type 1 NPI

Carly Joanna Thompson

Emotionally Disturbed Childrens' Residential Treatment Facility · Portland, OR

NPI number 1710174404 Active

Practice location

722 NE 162nd Ave
Portland, OR 97230-5760

Call (503) 255-4205 Map

Fax (503) 261-0988

Mailing address

3921 SE Salmon St
Portland, OR 97214-4432

Specialties and licenses

TaxonomyCodeLicense
Emotionally Disturbed Childrens' Residential Treatment Facility Primary 322D00000XNone listed

Emotionally Disturbed Childrens' Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

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About NPI 1710174404

Carly Joanna Thompson's National Provider Identifier is 1710174404, issued on Sep 26, 2007. The primary taxonomy on file is Emotionally Disturbed Childrens' Residential Treatment Facility (322D00000X), and the practice location is in Portland, OR. The record was last updated on Sep 26, 2007.