=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417822875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW SEASON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2025
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16420 SE DIVISION ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97236-1987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-762-3130
-----------------------------------------------------
Fax | 503-762-3199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9753 SE SPYGLASS DR
-----------------------------------------------------
City | HAPPY VALLEY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97086-7316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-334-2044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | MR. PRESTON A SHELTON
-----------------------------------------------------
Credential | CADC-R
-----------------------------------------------------
Telephone | 971-334-2044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------