Healthcare Provider Details

I. General information

NPI: 1225433881
Provider Name (Legal Business Name): GIL SYKES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE 7TH AVE
PORTLAND OR
97214-1200
US

IV. Provider business mailing address

200 SE 7TH AVE
PORTLAND OR
97214-1200
US

V. Phone/Fax

Practice location:
  • Phone: 503-972-9535
  • Fax:
Mailing address:
  • Phone: 503-972-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number97-10-91
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1673
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: