Individual
BEAU PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 NE 5TH ST., MCMINNVILLE, OR 97128
(503) 474-7750
Mailing address
1301 GOUCHER ST, AMITY, OR 97101-1215
(503) 474-7750
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
06/09/2022
Last updated
12/30/2024
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