IndividualActive
Carly Thompson
NPI 1710174404 · Emotionally Disturbed Childrens' Residential Treatment Facility · Portland, OR
Provider details
- NPI number
- 1710174404
- Entity type
- Individual
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
Practice location
722 Ne 162nd Ave
Portland, OR 97230-5760
Phone: (503) 255-4205
Fax: (503) 261-0988
Mailing address
3921 Se Salmon St
Portland, OR 97214-4432
Registry dates
- Enumerated
- 2007-09-26
- Last updated
- 2007-09-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.