MEDICARE: ANDREW CONNER

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1639539000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CONNER

Provider Business Mailing Address
First Line	:	11035 NE SANDY BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-2553
Country	:	US
Telephone Number	:	503-258-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 448
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2509
Country	:	US
Telephone Number	:	503-451-3450
Fax Number	:

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

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	11/09/2023

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Directions to “ ANDREW CONNER ” Practice Location

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