MEDICARE: HARRISON DANLEY CADCII

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	94-10-84	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	94-10-84	OTHER	OR	ACCBO

General Provider Information

NPI Number	:	1184167827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRISON DANLEY CADCII

Provider Business Mailing Address
First Line	:	3610 NE 82ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5182
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 NE 82ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5182
Country	:	US
Telephone Number	:	503-408-9585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	11/30/2016

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