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General NPI Number Information
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NPI Number | 1053850750
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Entity Type | Individual
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Provider Name | CARLOS JORGE VAZQUEZ JR. CADC,CGAC,QMHA,CRM
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Gender | Male
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 3800 SW CEDAR HILLS BLVD STE 170
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City | BEAVERTON
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State | OR
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Zip | 97005-2020
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Country | US
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Telephone | 503-626-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 SW CEDAR HILLS BLVD STE 170
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City | BEAVERTON
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State | OR
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Zip | 97005-2020
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Country | US
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Telephone | 503-626-1800
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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 | G-24-05-1018
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 23-QMHA-I-004029
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 21-CRM-704
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 23-CGRM-020
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23-06-20284
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License Number State | OR
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