Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003254111 |
---|---|
Provider Name | Hubert Mathews |
First Address | Portland, OR 97209-3609 |
Second Address | Portland, OR 97209-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 11/06/2013 |