Individual
EBERHEARDT BANE ELFVING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PWS, QMHA-R
Contact information
Practice address
5329 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97211-3237
(503) 988-5558
Mailing address
619 NW 6TH AVE FL 7, PORTLAND, OR 97209-3991
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
25-QMHA-R-7213
OR
175T00000X
Peer Specialist
Primary
THW000108617
OR
Other
Enumeration date
03/03/2023
Last updated
10/16/2025
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