Individual
ADOLFO JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-R/QMHP-R
Contact information
Practice address
421 SW OAK ST STE 520, PORTLAND, OR 97204-1810
(503) 988-5887
Mailing address
421 SW OAK ST STE 520, PORTLAND, OR 97204-1810
(503) 988-5887
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-22-1890
OR
101YM0800X
Mental Health Counselor
Primary
22-QMHP-R-1481
OR
104100000X
Social Worker
A13640
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500809625
—
OR
Enumeration date
08/03/2022
Last updated
01/26/2023
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