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Mike W Brockman, CADCII/QMHA-I
Addiction (Substance Use Disorder) Counselor in Portland, Oregon
NPI 1073641064

Mike W Brockman is an Addiction (Substance Use Disorder) Counselor based in Portland, OR and is specialized in Addiction (Substance Use Disorder). Mike W Brockman practices in Portland, OR and has the professional credentials of CADCII/QMHA-I. The NPI Number for Mike W Brockman is 1073641064 and holds a License No. 19-QMHA-I-01468 (Oregon).

The current practice location address for Mike W Brockman is 1631 Sw Columbia St, Portland, OR and can be reached out via phone at 503-231-2641 and via fax at 503-231-1654.

Location: 1631 Sw Columbia St, Portland, OR, 97205-1715
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Provider Profile Details
NPI Number
1073641064
Provider Name
Mike W Brockman
Credential
CADCII/QMHA-I
Provider Entity Type
Individual
Gender
Male
Address
1631 Sw Columbia St, Portland, OR, 97205-1715
Phone Number
503-231-2641
Fax Number
503-231-1654
Provider Enumeration Date
03/01/2007
Last Update Date
07/20/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
500694604 05 OR
500777728 05 OR
institution
Provider Business Practice Location Address Details
Address
1631 Sw Columbia St
City
State
Zip
97201-6025
Phone Number
503-231-2641
Fax Number
503-231-1654
person
Provider Business Mailing Address Details
Address
1631 Sw Columbia St
City
State
Zip
97201-6025
Phone Number
503-231-2641
Fax Number
503-231-1654
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
15-10-21 (Oregon)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
19-QMHA-I-01468 (Oregon)
Definition
Definition to come...
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