Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 01-03-17 | OR |
Y | 101YP2500X | Professional Counselor | C2268 | OR |
NPI | 1003970294 |
---|---|
Provider Name | Beth R James |
First Address | Portland, OR 97282-0819 |
Second Address | Hillsboro, OR 97124-9327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 15/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164936 | (05) | OR |