Healthcare Provider Details

I. General information

NPI: 1699641928
Provider Name (Legal Business Name): MICHAEL ANDRE EADS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SE BELMONT ST
PORTLAND OR
97214-2916
US

IV. Provider business mailing address

12608 SE SKYSHOW PL UNIT 324
HAPPY VALLEY OR
97086-4476
US

V. Phone/Fax

Practice location:
  • Phone: 503-239-5738
  • Fax:
Mailing address:
  • Phone: 503-239-5738
  • Fax: 503-239-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: