Healthcare Provider Details

I. General information

NPI: 1972417863
Provider Name (Legal Business Name): AMIRAH BATUL NAZARALI CADC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10763 SW GREENBURG RD # 100
PORTLAND OR
97223-5492
US

IV. Provider business mailing address

10763 SW GREENBURG RD # 100
PORTLAND OR
97223-5492
US

V. Phone/Fax

Practice location:
  • Phone: 503-342-8086
  • Fax:
Mailing address:
  • Phone: 425-623-7514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-26-6871
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: