Individual
FREDERICK BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3034 NE MLK BLVD, PORTLAND, OR 97212-3053
(503) 238-3763
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/08/2014
Last updated
01/08/2014
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