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General NPI Number Information
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NPI Number | 1184902504
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Entity Type | Individual
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Provider Name | KEVIN C. MIYASATO LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 12725 SW MILLIKAN WAY SUITE 300
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City | BEAVERTON
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State | OR
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Zip | 97005-1678
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Country | US
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Telephone | 503-906-7870
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Fax | 503-906-7871
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Provider Business Mailing Address
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Address Line | 12725 SW MILLIKAN WAY SUITE 300
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City | BEAVERTON
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State | OR
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Zip | 97005-1678
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Country | US
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Telephone | 503-906-7870
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Fax | 503-906-7871
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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 | 00686
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5214-S
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5855
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License Number State | OR
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