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NPI Code Detail

MEDICARE: ROBERT HARRIS

MEDICARE: ROBERT HARRIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1174862809
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT HARRIS
Provider Business Mailing Address
First Line : 6200 SE KING RD
Second Line :
City : PORTLAND
State : OR
Zip : 97222-2891
Country : US
Telephone Number : 503-546-6377
Fax Number :
Provider Business Practice Location Address
First Line : 6200 SE KING RD
Second Line :
City : PORTLAND
State : OR
Zip : 97222-2891
Country : US
Telephone Number : 503-546-6377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2013
Last Update Date : 04/19/2016

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