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General NPI Number Information
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NPI Number | 1184572166
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Entity Type | Individual
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Provider Name | GREG MINIKES MSW, QMHP-R
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Gender | Male
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 4101 NE DIVISION ST
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City | GRESHAM
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State | OR
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Zip | 97030-4617
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Country | US
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Telephone | 503-666-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 NE DIVISION ST
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City | GRESHAM
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State | OR
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Zip | 97030-4617
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OR
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