Organization
POLK COUNTY ALCOHOL AND DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG P HANSEN (POLK COUNTY ADMINISTRATIVE OFFICER)
(503) 623-8173
Entity
Organization
Contact information
Practice address
182 SW ACADEMY, SUITE #304, DALLAS, OR 97338-1922
(503) 623-9289
(503) 831-1726
Mailing address
182 SW ACADEMY ST, SUITE #310 POLK COUNTY ALCOHOL AND DRUG, DALLAS, OR 97338-1922
(503) 623-9317
(503) 623-2731
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CERTIFICATE OF APPRO
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132001
—
OR
Enumeration date
07/12/2006
Last updated
08/22/2020
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