Mike W Brockman in Portland - Addiction (substance Use Disorder)
Mike W Brockman - NPI 1073641064
Mike W Brockman is a Addiction (substance Use Disorder) in Portland, Oregon. Mike W Brockman practices all healthcare services and medical treatments related to Addiction (substance Use Disorder). The NPI Number for Mike W Brockman is 1073641064. The last update date is 2022-06-30.
Mike W Brockman's current location address is 1776 Sw Madison St, Portland, Oregon. You can contact this provider via phone number 9713862278 and fax number 5032244494. The mailing address for Mike W Brockman is 1776 Sw Madison St, Portland, Oregon. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Mike W Brockman |
|---|---|
| Address | 1776 Sw Madison St, Portland, Oregon |
| Phone Number | 9713862278 |
| Fax Number | 5032244494 |
| Sole Proprietor | N |
| Credentials | CADC II/QM |
NPI Number Detail
| NPI Number | 1073641064 |
|---|---|
| Provider Enumeration Date | 2007-03-01 |
| Last Updated Date | 2022-06-30 |
Provider Mailing Address Detail
| Address | 1776 Sw Madison St |
|---|---|
| City | Portland |
| State | Oregon (OR) |
| Post Code | 972051715 |
| Phone Number | 9713862278 |
| Fax Number | 5032244494 |
Provider's Primary Taxonomy Detail
| Speciality | Addiction (substance Use Disorder) |
|---|---|
| Taxonomy | 101Ya0400X |
| Licence No | 15-10-21 |
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Definition: A counselor who helps people with alcohol, drug, gambling, internet, and other types of addictions. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 500694604 | OR | -- | |
| 500777728 | OR | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Mike W Brockman by the Centers for Medicare & Medicaid Services (CMS)?
The Mike W Brockman has been assigned the NPI (National Provider Identifier) 1073641064. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you share the physical location details of Mike W Brockman?
The Mike W Brockman is situated at 1776 Sw Madison St, in the city of Portland, state of OR, with the zip code 972051715.
What is Mike W Brockman's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Mike W Brockman's specialized field of practice is Addiction (substance Use Disorder), and the corresponding taxonomy code that categorizes this area of specialization is 101Ya0400X.
On what date did the Mike W Brockman receive the assignment of its 1073641064 from the Centers for Medicare & Medicaid Services?
The Mike W Brockman was issued its 1073641064 by the Centers for Medicare & Medicaid Services on 2007-03-01.
As of what date were the details pertaining to Mike W Brockman last refreshed?
The information related to the Mike W Brockman, including its address, specialty, and other relevant details, was last updated on 2022-06-30.