| Vitellaria Llc | |
|
9735 Sw Shady Ln Ste 104 Tigard OR 97223-5481 | |
| (503) 707-6302 | |
| (503) 747-4023 |
| Full Name | Vitellaria Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 9735 Sw Shady Ln Ste 104, Tigard, Oregon |
| Authorized Official Name and Position | Sarah Paul (OWNER) |
| Authorized Official Contact | 5037813278 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitellaria Llc 7084 Sw 181st Pl Beaverton OR 97007-5252 Ph: (503) 781-3278 | Vitellaria Llc 9735 Sw Shady Ln Ste 104 Tigard OR 97223-5481 Ph: (503) 707-6302 |
| NPI Number | 1073257614 |
|---|---|
| Provider Enumeration Date | 04/20/2022 |
| Last Update Date | 01/24/2023 |
| Certification Date | 01/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073257614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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