Individual
COREY DEAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5120 SE 118TH AVE, PORTLAND, OR 97266-3250
(503) 762-3431
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
OR
Enumeration date
12/08/2011
Last updated
03/27/2014
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