Healthcare Provider Details

I. General information

NPI: 1639872435
Provider Name (Legal Business Name): GRACE MARIE BEZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 NE 42ND AVE
PORTLAND OR
97213-1322
US

IV. Provider business mailing address

2539 NE INVERNESS DR
HILLSBORO OR
97124-7612
US

V. Phone/Fax

Practice location:
  • Phone: 503-966-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT3231
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: