Individual
SEAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1122 NE 122ND AVE STE 102, PORTLAND, OR 97230-2081
(310) 750-8960
Mailing address
11006 SE HENDERSON DR, PORTLAND, OR 97266-5063
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-18-469
OR
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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