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NPI Code Detail

MEDICARE: ELIZABETH CHENVEN

MEDICARE: ELIZABETH CHENVEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1073610085
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CHENVEN
Provider Business Mailing Address
First Line : 4343 SE 30TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3539
Country : US
Telephone Number : 503-839-1712
Fax Number :
Provider Business Practice Location Address
First Line : 9670 SW BEAVERTON HILLSDALE HWY
Second Line :
City : BEAVERTON
State : OR
Zip : 97005-3307
Country : US
Telephone Number : 503-626-9494
Fax Number : 503-646-8401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 03/03/2009

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