Individual
COREY VETIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1427 NW 23RD AVE, PORTLAND, OR 97210-2660
(614) 323-5023
Mailing address
4505 NE HOYT ST, PORTLAND, OR 97213-2338
(614) 323-5023
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OR
Other
Enumeration date
05/21/2024
Last updated
11/30/2024
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