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General NPI Number Information
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NPI Number | 1376202846
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Entity Type | Individual
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Provider Name | PETER RAGEN MA
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Gender | Male
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 10580 SW MCDONALD ST STE 202
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City | PORTLAND
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State | OR
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Zip | 97224-4800
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Country | US
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Telephone | 503-847-9697
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 S CAREY LN
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City | PORTLAND
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State | OR
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Zip | 97219-7949
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Country | US
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Telephone | 503-388-8675
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | R9163
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License Number State | OR
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