Individual
MR. KEVIN ROBERT MINOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
847 NE 19TH AVE, SUITE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
27163
CA
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
27163
CA
1041C0700X
Clinical Social Worker
29596
CA
1041C0700X
Clinical Social Worker
Primary
L6933
OR
Other
Enumeration date
04/23/2010
Last updated
04/15/2016
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