Individual
MICHAEL JAMES GUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1800 NE MARKET DR, FAIRVIEW, OR 97024-7000
(503) 220-8262
Mailing address
23937 SW RED FERN DR, SHERWOOD, OR 97140-6283
(805) 276-0764
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L10299
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L10299
LICENSED CLINICAL SOCIAL WORKER
OR
Enumeration date
02/01/2021
Last updated
02/04/2021
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