Individual provider · Type 1 NPI

Frederick Douglass Staten, PhD, LPC, CADC III

Professional Counselor · Portland, OR

NPI number 1417216730 Active

Practice location

10920 SW Barbur Blvd
Portland, OR 97219-8600

Call (503) 244-4500 Map

Fax (503) 244-2008

Mailing address

PO Box 8459
Portland, OR 97207-8459

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor 101YP2500XLH60296096 (WA)
Professional Counselor Primary 101YP2500XC4765 (OR)
Addiction (Substance Use Disorder) Counselor 101YA0400XNone listed

Professional Counselor: Definition to come...

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About NPI 1417216730

Frederick Douglass Staten, PhD, LPC, CADC III's National Provider Identifier is 1417216730, issued on May 7, 2012. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Portland, OR. The record was last updated on Mar 13, 2026.