Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003121633 |
---|---|
Provider Name | Brian Beeghly |
First Address | Portland, OR 97202-1552 |
Second Address | Portland, OR 97202-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2010 |
Last Update Date | 06/08/2010 |