Healthcare Provider Details

I. General information

NPI: 1548818255
Provider Name (Legal Business Name): DAVID ALAN BERENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 SE MARLIN AVE
WARRENTON OR
97146-9624
US

IV. Provider business mailing address

1320 FRANKLIN AVE APT A
ASTORIA OR
97103-3950
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-5722
  • Fax:
Mailing address:
  • Phone: 503-758-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: