MEDICARE: LYNN A SMITH-STOTT CDP

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	CP00006104	WA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	10-12-80	OR
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861717332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN A SMITH-STOTT CDP

Provider Business Mailing Address
First Line	:	232 NW 6TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-3609
Country	:	US
Telephone Number	:	503-200-3923
Fax Number	:	503-241-7419

Provider Business Practice Location Address
First Line	:	709 NW EVERETT
Second Line	:	BLDG 17, STE 222
City	:	PORTLAND
State	:	OR
Zip	:	97209-4060
Country	:	US
Telephone Number	:	503-226-4060
Fax Number	:	503-445-4913

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

Provider Enumeration Date	:	03/28/2010
Last Update Date	:	06/28/2011

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