Individual
AUSTIN GIPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1550 NW 14TH AVE APT 211, PORTLAND, OR 97209-2579
(503) 999-1718
Mailing address
1550 NW 14TH AVE APT 211, PORTLAND, OR 97209-2579
(503) 999-1718
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-23-3395
OR
175T00000X
Peer Specialist
Primary
THW000109078
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
03/29/2023
Last updated
12/14/2023
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