Individual
LOKI TWO OWLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-R CRM
Contact information
Practice address
211 NE 18TH AVE, PORTLAND, OR 97232-2822
(971) 248-8899
Mailing address
6705 SE 77TH AVE, PORTLAND, OR 97206-7105
(503) 765-0599
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-25-5438
OR
Other
Enumeration date
06/25/2025
Last updated
06/25/2025
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