Provider Demographics
NPI:1366189797
Name:EASTSIDE CHILD AND FAMILY THERAPY, LLC
Entity type:Organization
Organization Name:EASTSIDE CHILD AND FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLUPIG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-389-0542
Mailing Address - Street 1:320 N MAIN AVE STE 201A
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7242
Mailing Address - Country:US
Mailing Address - Phone:503-389-0542
Mailing Address - Fax:503-405-4239
Practice Address - Street 1:320 N MAIN AVE STE 201A
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7242
Practice Address - Country:US
Practice Address - Phone:503-389-0542
Practice Address - Fax:503-405-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty