Healthcare Provider Details

I. General information

NPI: 1730551417
Provider Name (Legal Business Name): CARSON MCKEE CASE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD STE 701
GRESHAM OR
97030-5770
US

IV. Provider business mailing address

2821 SE 71ST AVE
PORTLAND OR
97206-1126
US

V. Phone/Fax

Practice location:
  • Phone: 503-740-1971
  • Fax: 503-771-2436
Mailing address:
  • Phone: 541-944-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-5549
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number25-QMHA-R-7652
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLS101F8S
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: