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General NPI Number Information
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NPI Number | 1366878480
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Entity Type | Individual
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Provider Name | CONNOR C. JUNG
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Gender | Male
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 709 NW EVERETT ST
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City | PORTLAND
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State | OR
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Zip | 97209-3517
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Country | US
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Telephone | 971-352-8745
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Fax |
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Provider Business Mailing Address
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Address Line | 232 NW 6TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-3609
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12223
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 71590
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C7033
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License Number State | OR
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