Individual
KOURTNEY KAY IRISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3700 MIDWAY DR, BAKER CITY, OR 97814-1456
(541) 523-8320
(541) 523-8325
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-23-3112
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2737990
DRIVERS LICENSE
OR
Enumeration date
10/04/2023
Last updated
10/04/2023
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