Individual
MR. CLARK MINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS, CADC2, QMHA2,
Contact information
Practice address
10600 SE MCLOUGHLIN BLVD STE 207, MILWAUKIE, OR 97222-7428
(855) 770-0577
(503) 654-1852
Mailing address
10600 SE MCLOUGHLIN BLVD STE 207, MILWAUKIE, OR 97222-7428
(855) 770-0577
(503) 654-1852
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16-01-07
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21-11-20118
OR
Other
Enumeration date
01/26/2018
Last updated
04/21/2026
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