Healthcare Provider Details

I. General information

NPI: 1629584529
Provider Name (Legal Business Name): MARK ANTHONY RIOUX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 01/31/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 SE BALFOUR ST
MILWAUKIE OR
97222-6426
US

IV. Provider business mailing address

6601 NE 78TH CT STE A3
PORTLAND OR
97218-2823
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-2575
  • Fax: 503-659-5182
Mailing address:
  • Phone: 35-252-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: