Individual
SEAN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC I, CRM
Contact information
Practice address
10564 SE WASHINGTON STREET, PORTLAND, OR 97216
(971) 806-0571
Mailing address
2318 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97212-3715
(503) 335-8611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20-07-07
OR
175T00000X
Peer Specialist
16-CRM-008
OR
Other
Enumeration date
02/09/2016
Last updated
08/11/2020
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