Individual
SHAWN E SHULTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSW, CADC I, QMHA
Contact information
Practice address
12662 SE STARK ST STE A, PORTLAND, OR 97233-1058
(503) 546-7677
Mailing address
12662 SE STARK ST STE A, PORTLAND, OR 97233-1058
(503) 546-7677
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316469596
—
OR
Enumeration date
07/10/2017
Last updated
09/18/2023
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