Organization
KONRAD VON WALTHER LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KONRAD A VON WALTHER LCSW (OWNER)
(503) 985-9640
Entity
Organization
Contact information
Practice address
443 NE KNOTT ST, PORTLAND, OR 97212-3108
(971) 645-9810
Mailing address
443 NE KNOTT ST, PORTLAND, OR 97212
(503) 985-9640
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16-02-15
OR
1041C0700X
Clinical Social Worker
Primary
6961
OR
Other
Enumeration date
03/14/2017
Last updated
03/16/2017
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