Individual provider · Type 1 NPI

Mike W. Brockman, CADC II/QMHA-I

Addiction (Substance Use Disorder) Counselor · Portland, OR

NPI number 1073641064 Active

Practice location

1631 SW Columbia St
Portland, OR 97201-6025

Call (503) 231-2641 Map

Fax (503) 231-1654

Mailing address

1776 SW Madison St
Portland, OR 97205-1715

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800X19-QMHA-I-01468 (OR)
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X15-10-21 (OR)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1073641064

Mike W. Brockman, CADC II/QMHA-I's National Provider Identifier is 1073641064, issued on Mar 1, 2007. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Portland, OR. The record was last updated on Jul 1, 2024.