Individual
STEPHANIE MICHELLE BILLMYRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 NE 165TH AVE, PORTLAND, OR 97230-6102
(971) 353-8052
Mailing address
PO BOX 1614, CLACKAMAS, OR 97015-1614
(971) 277-0601
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500804330
—
OR
Enumeration date
03/16/2018
Last updated
04/26/2022
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