MEDICARE: NATE ETHERLY

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	101Y00000X	Counselor		OR

General Provider Information

NPI Number	:	1417811241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATE ETHERLY

Provider Business Mailing Address
First Line	:	10731 SW COTTONWOOD ST
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8171
Country	:	US
Telephone Number	:	503-877-8552
Fax Number	:

Provider Business Practice Location Address
First Line	:	10731 SW COTTONWOOD ST
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8171
Country	:	US
Telephone Number	:	503-877-8552
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ NATE ETHERLY ” Practice Location

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