Individual
KIEL JUSTIN TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5441 S MACADAM AVE STE R, PORTLAND, OR 97239-3822
(425) 678-6463
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
R9212
OR
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/12/2021
Last updated
05/14/2026
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