Individual
MIKE TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC II
Contact information
Practice address
3580 SE 82ND AVE, PORTLAND, OR 97266-2902
(971) 339-9240
Mailing address
324 NW DAVIS STREET, PORTLAND, OR 97209-9720
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14-03-33
OR
Other
Enumeration date
04/11/2016
Last updated
11/02/2023
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