Individual
NATHANIEL SELLAND PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
537 SE ALDER ST, PORTLAND, OR 97214-2231
(503) 230-9654
(503) 239-5953
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
09/14/2011
Last updated
10/26/2018
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