Individual
LORI A BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM/PSS
Contact information
Practice address
1631 SW COLUMBIA ST, PORTLAND, OR 97201-6025
(503) 231-2641
(503) 231-1654
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20-CRM-092
OR
175T00000X
Peer Specialist
THW000104020
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500785339
—
OR
Enumeration date
09/30/2020
Last updated
10/25/2022
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