Healthcare Provider Details

I. General information

NPI: 1811635378
Provider Name (Legal Business Name): MICHAEL DAVID ATKINS PCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 04/05/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 NW OVERLOOK CT
GRESHAM OR
97030-6919
US

IV. Provider business mailing address

286 NW OVERLOOK CT
GRESHAM OR
97030-6919
US

V. Phone/Fax

Practice location:
  • Phone: 971-334-4783
  • Fax:
Mailing address:
  • Phone: 971-334-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8088
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: