Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | C3002 | OR |
NPI | 1003185935 |
---|---|
Provider Name | Mr. Anthony Francis Marchant |
First Address | Portland, OR 97223-9323 |
Second Address | Portland, OR 97223-9323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2011 |
Last Update Date | 22/08/2013 |