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General NPI Number Information
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NPI Number | 1366713075
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Entity Type | Individual
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Provider Name | MATTHEW VINSON MSW, LCSW, CADC III
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Gender | Male
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 08/11/2019
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Provider Practice Location Address
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Address Line | 1009 NW SPRUCE AVE
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City | REDMOND
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State | OR
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Zip | 97756-1212
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Country | US
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Telephone | 541-891-9841
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 NW SPRUCE AVE
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City | REDMOND
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State | OR
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Zip | 97756-1212
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Country | US
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Telephone | 541-891-9841
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16-05-19
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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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 | 7785
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L7785
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License Number State | OR
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