Individual provider · Type 1 NPI

Maxwell Dietmar Boenisch

Mental Health Counselor · Portland, OR

NPI number 1326861360 Active

Practice location

4212 SE Division St
Portland, OR 97206-1680

Call (503) 238-0705 Map

Fax (503) 236-7166

Mailing address

PO Box 8459
Portland, OR 97207-8459

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1326861360

Maxwell Dietmar Boenisch's National Provider Identifier is 1326861360, issued on Nov 7, 2024. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Nov 7, 2024.