Individual
JOSEPH BONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, CADC 3
Contact information
Practice address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 267-2127
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 267-2127
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15-05-06
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
18-02-29
OR
101YP2500X
Professional Counselor
Primary
C5095
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500181599
—
OR
Enumeration date
03/10/2015
Last updated
01/14/2023
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