Individual
MIKE W BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC II/QMHA-I
Contact information
Practice address
1631 SW COLUMBIA ST, PORTLAND, OR 97201-6025
(503) 231-2641
(503) 231-1654
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(971) 386-2278
(503) 224-4494
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15-10-21
OR
101YM0800X
Mental Health Counselor
19-QMHA-I-01468
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500694604
—
OR
05
—
500777728
—
OR
Enumeration date
03/01/2007
Last updated
07/01/2024
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