Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 12-06-92 | OR |
N | 101YM0800X | Mental Health Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1275809188 |
---|---|
Provider Name | Mr. Brandon Michael Schwanz |
First Address | Portland, OR 97205-1703 |
Second Address | Portland, OR 97205-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2012 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1568401347 | (05) | OR |