Individual
KILLIAN DRAKE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHP
Contact information
Practice address
1650 NE 32ND AVE APT 418, PORTLAND, OR 97232-3454
(541) 340-9016
Mailing address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3690
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
06/21/2016
Last updated
06/03/2022
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