Healthcare Provider Details

I. General information

NPI: 1902793052
Provider Name (Legal Business Name): AARON L BURRELL CADC-R
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21440 SE STARK ST
GRESHAM OR
97030-2024
US

IV. Provider business mailing address

11010 SE DIVISION ST STE 11104SE
PORTLAND OR
97266-6400
US

V. Phone/Fax

Practice location:
  • Phone: 971-703-4623
  • Fax:
Mailing address:
  • Phone: 971-703-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9819502
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: