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General NPI Number Information
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NPI Number | 1013509041
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Entity Type | Individual
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Provider Name | PATRICK TYLER BLUETT
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Gender | Male
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 8083 SE 13TH AVE STE 3
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City | PORTLAND
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State | OR
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Zip | 97202-6668
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Country | US
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Telephone | 971-350-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 2585 SE MARTHA CT
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City | MILWAUKIE
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State | OR
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Zip | 97222-6064
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Country | US
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Telephone | 503-730-7478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | R6279
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License Number State | OR
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