Individual
BEN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
727 NE 24TH AVE, PORTLAND, OR 97232-2222
(503) 228-9229
Mailing address
727 NE 24TH AVE, PORTLAND, OR 97232-2222
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/21/2010
Last updated
09/21/2010
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