Individual
CHERI TYNAN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7934 S/E KNIGHT ST, PORTLAND, OR 97206-5859
(971) 832-0672
Mailing address
7934 SE KNIGHT ST, PORTLAND, OR 97206-5859
(971) 832-0672
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
175T00000X
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175T00000X
PEER SUPPORT SPECALIST
OR
Enumeration date
09/01/2016
Last updated
09/01/2016
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