Individual
ANTHONY MICHELL LATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-1/QMHP
Contact information
Practice address
10763 SW GREENBURG RD, TIGARD, OR 97223-5492
(503) 684-8159
Mailing address
10763 SW GREENBURG RD, TIGARD, OR 97223-5492
(503) 684-8159
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24-07-11201
OR
101YM0800X
Mental Health Counselor
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500813163
—
OR
05
—
500813165
—
OR
Enumeration date
11/16/2021
Last updated
11/25/2025
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