Individual
KEVIN C. MIYASATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
12725 SW MILLIKAN WAY, SUITE 300, BEAVERTON, OR 97005-1678
(503) 906-7870
(503) 906-7871
Mailing address
12725 SW MILLIKAN WAY, SUITE 300, BEAVERTON, OR 97005-1678
(503) 906-7870
(503) 906-7871
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
00686
NV
1041C0700X
Clinical Social Worker
5214-S
NV
1041C0700X
Clinical Social Worker
Primary
5855
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500670052
—
OR
Enumeration date
08/02/2011
Last updated
06/06/2014
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