Individual
MR. EOIN BASTABLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4520 NE 32ND PL, PORTLAND, OR 97211-7710
(503) 360-7011
Mailing address
4520 NE 32ND PL, PORTLAND, OR 97211-7710
(503) 360-7011
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
L11451
OR
Other
Enumeration date
01/30/2007
Last updated
01/11/2024
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