Healthcare Provider Details

I. General information

NPI: 1881500262
Provider Name (Legal Business Name): DEREK DEVOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 SW HIGHLAND AVE STE 3
REDMOND OR
97756-2558
US

IV. Provider business mailing address

1655 SW HIGHLAND AVE STE 3
REDMOND OR
97756-2558
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-2654
  • Fax: 541-550-2011
Mailing address:
  • Phone: 541-923-2654
  • Fax: 541-550-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: