Individual
JUSTYN REID STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-I, PSS, CRM
Contact information
Practice address
1333 NW 9TH ST, PRINEVILLE, OR 97754-1482
(541) 447-2631
Mailing address
1356 NW DAVENPORT AVE, BEND, OR 97703-3077
(541) 699-9226
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21-11-10279
OR
Other
Enumeration date
07/26/2022
Last updated
09/15/2022
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