Healthcare Provider Details

I. General information

NPI: 1760745020
Provider Name (Legal Business Name): BENJAMIN PAZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 GATEWAY AVE STE 210
ASTORIA OR
97103-6035
US

IV. Provider business mailing address

422 GATEWAY AVE STE 210
ASTORIA OR
97103-6035
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-4584
  • Fax: 503-741-3089
Mailing address:
  • Phone: 503-325-4584
  • Fax: 503-741-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2860
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2860
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: