Individual
P. KELLY FITZPATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, NCAC II, QMHA
Contact information
Practice address
10570 SE WASHINGTON ST, SUITE 201, PORTLAND, OR 97216-2846
(503) 933-2440
Mailing address
PO BOX 16756, PORTLAND, OR 97292-0756
(503) 208-2596
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
07-09-60
OR
175T00000X
Peer Specialist
15-CRM-167
OR
Other
Enumeration date
07/22/2010
Last updated
12/14/2016
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