Individual
CARSON MCKEE CASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1217 NE BURNSIDE RD STE 701, GRESHAM, OR 97030-5770
(503) 740-1971
(503) 771-2436
Mailing address
2821 SE 71ST AVE, PORTLAND, OR 97206-1126
(541) 944-5648
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
25-QMHA-R-7652
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-25-5549
OR
174400000X
Specialist
LS101F8S
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25-QMHA-R-7652
QMHA-R
OR
01
—
LS101F8S
LMT
OR
01
—
T-25-5549
CADC-R
OR
Enumeration date
10/21/2015
Last updated
03/03/2026
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