Individual
RICK LAVERN MATHIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
10101 SW BARBUR BLVD STE 101, PORTLAND, OR 97219-5915
(503) 245-6262
(503) 245-6263
Mailing address
10101 SW BARBUR BLVD STE 101, PORTLAND, OR 97219-5915
(503) 245-6262
(503) 245-6263
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17-11-20
OR
Other
Enumeration date
01/17/2018
Last updated
01/17/2018
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