38D2094896 CLIA NUMBER - STULTS HOUSE OREGON (RTH)

Laboratory Demographics

CLIA Code: 38D2094896
Facility Name: STULTS HOUSE OREGON (RTH)
Facility Address: 805 SE 151 ST
PORTLAND, OR
ZIP 97233
Facility Phone: 971 271-7270
Facility Type: Other - COUNSELLOR
Facility Type: Waiver
Lab Director: JAMIE DERUYTER LPC
NPI Number: 1780043802
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	38D2094896
LAB Type	Other - COUNSELLOR
Facility Name	STULTS HOUSE OREGON (RTH)
Street	805 SE 151 ST
City	PORTLAND
State	OR
ZIP	97233
Phone	971 271-7270
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	4/27/2025
Certificate Expiration Date	4/26/2027
Facility Type	Other - COUNSELLOR
Lab Director	JAMIE DERUYTER LPC

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This page was last updated on: 9/29/2025