MEDICARE: MS. NICOLE CORBIN LAWSON QMHP,LPC,CADC

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	02-11-23	OR
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	C1230	OR

General Provider Information

NPI Number	:	1942223367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE CORBIN LAWSON QMHP,LPC,CADC

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207-8459
Country	:	US
Telephone Number	:	503-957-4936
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 SE 43RD AVE
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97206-1600
Country	:	US
Telephone Number	:	503-872-0151
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/17/2008

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