NPIMap

Erick Allen, CADC1

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Portland, OR

NPI 1760145395 · NPPES record last updated Oct 20, 2021

Key facts

NPI
1760145395
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
21-1010253 (OR)
Practice address
1817 NE 6TH Ave
Portland, OR 97212-3960
Phone
(503) 719-7985
NPI assigned
Oct 20, 2021
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
21-1010253ORMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Change Clinic, LLC Current
since Nov 21, 2021		 Accepting new patients

Locations

1817 NE 6th Ave
Portland, OR 97212
Phone (503) 719-7985

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 21-1010253 OR Yes

Addresses

Primary practice location

1817 NE 6TH Ave
Portland, OR 97212-3960

Mailing address

PO Box 16816
Portland, OR 97292-0816
Phone (503) 890-7356

Other providers in Portland, OR

All providers in Portland, OR · Addiction (Substance Use Disorder) Counselor in Oregon

Sources for this page

Verify at the official NPI Registry.