Healthcare Provider Details

I. General information

NPI: 1720674518
Provider Name (Legal Business Name): DANIEL F BOLTON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 SW BARNES RD STE 205
PORTLAND OR
97225-6629
US

IV. Provider business mailing address

9155 SW BARNES RD STE 205
PORTLAND OR
97225-6629
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-2025
  • Fax:
Mailing address:
  • Phone: 503-216-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8336
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: