Individual
EVAN C HIATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCR/CRM/PSS/QMHA-R
Contact information
Practice address
620 NE 2ND ST, GRESHAM, OR 97030-7514
(971) 274-3757
(503) 912-5740
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20-CRM-280
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-21-713
OR
101YM0800X
Mental Health Counselor
21-QMHA-R-1025
OR
175T00000X
Peer Specialist
THW000104413
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500799708
—
OR
05
—
500799772
—
OR
Enumeration date
09/28/2021
Last updated
03/17/2022
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