Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | OR |
NPI | 1003578634 |
---|---|
Provider Name | Jacob Erin Scott |
First Address | Portland, OR 97216-2809 |
Second Address | Portland, OR 97216-2809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2021 |
Last Update Date | 11/10/2021 |