Healthcare Provider Details

I. General information

NPI: 1801702568
Provider Name (Legal Business Name): ANTHONY BETZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY BETZ

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 SW BOONES FERRY RD
TUALATIN OR
97062-8496
US

IV. Provider business mailing address

5441 S MACADAM AVE STE R
PORTLAND OR
97239-3822
US

V. Phone/Fax

Practice location:
  • Phone: 503-783-8532
  • Fax:
Mailing address:
  • Phone: 503-217-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR10088
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: