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General NPI Number Information
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NPI Number | 1174905210
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Entity Type | Individual
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Provider Name | JOHN OTTS LPC, CADCIII
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Gender | Male
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 6600 SW 105TH AVE SUITE 120
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City | BEAVERTON
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State | OR
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Zip | 97008-8832
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Country | US
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Telephone | 503-867-1259
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Fax | 503-867-1259
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Provider Business Mailing Address
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Address Line | 2073 SW PARK AVE 216
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City | PORTLAND
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State | OR
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Zip | 97201-3122
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Country | US
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Telephone | 503-867-1259
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Fax | 503-867-1259
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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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 | C4480
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License Number State | OR
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