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NPI Code Detail

MEDICARE: TIMOTHY WILLIAM GRIEVE CADC II

MEDICARE: TIMOTHY WILLIAM GRIEVE CADC II
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) Counselor14-03-27OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114-03-27OTHERORACCBO/CADC II

General Provider Information

NPI Number : 1558752717
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY WILLIAM GRIEVE CADC II
Provider Business Mailing Address
First Line : 1027 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1328
Country : US
Telephone Number : 503-239-8400
Fax Number : 503-269-8407
Provider Business Practice Location Address
First Line : 1427 SE 182ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97233-5008
Country : US
Telephone Number : 503-761-6006
Fax Number : 503-761-1434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2015
Last Update Date : 02/10/2015

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Directions to “ TIMOTHY WILLIAM GRIEVE CADC II” Practice Location

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