MEDICARE: EBONY ASHLEY FLAHERTY

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YM0800X	Mental Health Counselor	C3181	OR

General Provider Information

NPI Number	:	1427354240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY ASHLEY FLAHERTY

Provider Business Mailing Address
First Line	:	975 SE SANDY BLVD # 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1399
Country	:	US
Telephone Number	:	503-805-7034
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 SE SANDY BLVD # 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1399
Country	:	US
Telephone Number	:	503-805-7034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	11/27/2023

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Directions to “ EBONY ASHLEY FLAHERTY ” Practice Location

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