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General NPI Number Information
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NPI Number | 1538603618
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Entity Type | Individual
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Provider Name | MR. MICHAEL PETER HIGGINBOTHAM II
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Gender | Male
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 843 PITTVIEW AVE
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City | CENTRAL POINT
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State | OR
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Zip | 97502-2948
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Country | US
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Telephone | 503-298-0249
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Fax | 541-386-7982
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Provider Business Mailing Address
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Address Line | 843 PITTVIEW AVE
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City | CENTRAL POINT
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State | OR
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Zip | 97502-2948
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Country | US
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Telephone | 503-298-0249
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Fax | 541-630-4767
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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 |
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License Number State |
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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 | C6150
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | R4989
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C6150
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License Number State | OR
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