Healthcare Provider Details

I. General information

NPI: 1184127318
Provider Name (Legal Business Name): PATRICK ORLO PORTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3571 COLUMBIA PKWY STE 1
CINCINNATI OH
45226-2137
US

IV. Provider business mailing address

3571 COLUMBIA PKWY STE 1
CINCINNATI OH
45226-2137
US

V. Phone/Fax

Practice location:
  • Phone: 513-254-1300
  • Fax:
Mailing address:
  • Phone: 513-321-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.166308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: