Healthcare Provider Details

I. General information

NPI: 1760869523
Provider Name (Legal Business Name): GARRETT TAYLOR BACHMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date: 01/22/2022
Reactivation Date: 02/21/2022

III. Provider practice location address

511 MAIN ST STE 203
OREGON CITY OR
97045-1830
US

IV. Provider business mailing address

511 MAIN ST STE 203
OREGON CITY OR
97045-1830
US

V. Phone/Fax

Practice location:
  • Phone: 971-389-7218
  • Fax: 503-386-2587
Mailing address:
  • Phone: 971-389-7218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10862
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL10862
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: