Healthcare Provider Details

I. General information

NPI: 1922149699
Provider Name (Legal Business Name): JUNE STINSON MOBLEY CADCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 SE SUNNYSIDE RD STE 200
CLACKAMAS OR
97015-5721
US

IV. Provider business mailing address

9775 SE SUNNYSIDE RD STE 200
CLACKAMAS OR
97015-5721
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-8471
  • Fax:
Mailing address:
  • Phone: 503-655-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10574
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
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: