Individual
NATHAN KENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM, CADC R
Contact information
Practice address
1217 NE BURNSIDE RD STE 701, GRESHAM, OR 97030-5770
(503) 740-6449
Mailing address
10117 SE SUNNYSIDE RD # F1217, CLACKAMAS, OR 97015-7708
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
01/15/2025
Last updated
01/15/2025
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