Individual
MR. BRADLEY PAUL ROAN EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(605) 516-0083
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
CADC-RT-20-486
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-20-486
OR
171M00000X
Case Manager/Care Coordinator
20-QMHA-R-0842
OR
175T00000X
Peer Specialist
21-CRM-411
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-CRM-411
CRM CERTIFICATE - MHACBO
OR
05
—
50079031
—
OR
Enumeration date
12/20/2019
Last updated
11/17/2025
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