Healthcare Provider Details

I. General information

NPI: 1306330394
Provider Name (Legal Business Name): RICHARD HALPERN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 SW BARBUR BLVD STE 105A
PORTLAND OR
97219-5934
US

IV. Provider business mailing address

4600 SW DICKINSON ST APT 7
PORTLAND OR
97219-0901
US

V. Phone/Fax

Practice location:
  • Phone: 541-490-1551
  • Fax:
Mailing address:
  • Phone: 541-490-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number340097E
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: