Provider Demographics
NPI:1255859583
Name:BRETT STITHEM, LCSW
Entity type:Organization
Organization Name:BRETT STITHEM, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:STITHEM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-575-8152
Mailing Address - Street 1:5623 NE 11TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4274
Mailing Address - Country:US
Mailing Address - Phone:773-575-8152
Mailing Address - Fax:833-288-5249
Practice Address - Street 1:1829 NE ALBERTA ST STE 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5881
Practice Address - Country:US
Practice Address - Phone:773-575-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ORL7183261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health