Individual
AMY MARIE ELNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC II/QMHA-R
Contact information
Practice address
620 NE 2ND ST, GRESHAM, OR 97030-7514
(971) 274-3757
(503) 912-5740
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24-11-20503
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
A011050315
CA
101YM0800X
Mental Health Counselor
24-QMHA-R-5811
OR
Other
Enumeration date
08/16/2024
Last updated
11/26/2024
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