Individual
TATE AVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(480) 267-6998
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(480) 267-6998
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MI401P7W
—
OR
Enumeration date
08/29/2022
Last updated
09/19/2023
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