MEDICARE: OLGA V PARKER PH.D.

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	04-07-65U3	OR
2	101YM0800X	Mental Health Counselor
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861563157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA V PARKER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 66344
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97290-6344
Country	:	US
Telephone Number	:	503-781-9065
Fax Number	:	503-761-6662

Provider Business Practice Location Address
First Line	:	605 SE 39TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-3216
Country	:	US
Telephone Number	:	503-231-7480
Fax Number	:	503-731-9574

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/10/2007

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