MEDICARE: KATHLEEN FLORES

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	15-12-07	OR

General Provider Information

NPI Number	:	1730548694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN FLORES

Provider Business Mailing Address
First Line	:	2600 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2916
Country	:	US
Telephone Number	:	503-239-5738
Fax Number	:

Provider Business Practice Location Address
First Line	:	7916 SE FOSTER RD STE 201
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-4289
Country	:	US
Telephone Number	:	503-374-3731
Fax Number	:	971-302-7469

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

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	04/25/2018

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Directions to “ KATHLEEN FLORES ” Practice Location

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