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General NPI Number Information
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NPI Number | 1265554257
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Entity Type | Individual
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Provider Name | DOUGLASS MCDONALD RUTH M.S.W., L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 1221 SW YAMHILL ST SUITE 301
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City | PORTLAND
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State | OR
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Zip | 97205-2126
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Country | US
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Telephone | 503-226-7079
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Fax | 503-226-1130
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Provider Business Mailing Address
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Address Line | 4213 NE 28TH AVE
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City | PORTLAND
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State | OR
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Zip | 97211-7103
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Country | US
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Telephone | 503-705-3134
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Fax | 440-756-1547
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L004513
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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