Individual
MARK ANTHONY HALLORAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSS CRM QMHAR CADCR
Contact information
Practice address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409
(971) 727-8026
Mailing address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409
(971) 727-8026
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-24-4760
OR
171M00000X
Case Manager/Care Coordinator
Primary
24-QMHA-R6242
OR
175T00000X
Peer Specialist
000106008
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000106008
TRADITIONAL HEALTH WORKER
OR
Enumeration date
01/25/2023
Last updated
02/10/2025
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