Individual
MR. NATHANIEL RICHARD CONKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA, CLINICAL COUNS
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
(503) 238-0769
Mailing address
950 CEDAR WAY SE, SALEM, OR 97302-3111
(503) 990-4506
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADC II, 13-12-54
OR
101YM0800X
Mental Health Counselor
CADCII: 13-12-54
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/28/2012
Last updated
04/11/2017
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