Doctor Name: | GORDON D MILLIGAN |
NPI Number: | 1770989840 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CADC I |
License Number: | 10-03-24 |
Business Practice Address: | 2318 Ne Martin Luther King Jr Blvd Portland, OR - 972123715 |
Business Phone Number: | 5033358611 |
Business Fax Number: | |
Mailing Address: | 2318 Ne Martin Luther King Jr Blvd, PORTLAND |
State: | OR |
Postal Code: | 972123715 |
Phone Number: | 5033358611 |
Fax Number: | |
NPI Enumeration Date: | 11/17/2014 |
NPI Last Update Date: | 02/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 10-03-24 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |