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NPI Code Detail

MEDICARE: MR. ERIC PASCAL SEVOS LCSW, QMHP

MEDICARE: MR. ERIC PASCAL SEVOS LCSW, QMHP
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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1821143199
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC PASCAL SEVOS LCSW, QMHP
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 310 NW FLANDERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3941
Country : US
Telephone Number : 503-827-3949
Fax Number : 503-827-0931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 03/25/2008

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1558415091 — MICHAEL RICHARD BROCK QMHA
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