Individual
PATRICK G EAGLE STAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PWS/QMHP-C
Contact information
Practice address
1310 SW 17TH AVE, PORTLAND, OR 97201-2522
(503) 231-2641
(503) 467-4077
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(971) 386-2278
(503) 224-4494
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
19-QMHPC-00380
OR
175T00000X
Peer Specialist
Primary
THW0002219
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500733968
—
OR
05
—
500761421
—
OR
Enumeration date
06/12/2017
Last updated
05/24/2019
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