Individual
ROBERT O DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
46314 TIMINE WAY, PENDLETON, OR 97801
(541) 966-9830
Mailing address
PO BOX 160, PENDLETON, OR 97801
(541) 966-9830
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-17-405
OR
405300000X
Prevention Professional
Primary
21-CRM-569
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-17-405
MHACBO
OR
Enumeration date
07/07/2021
Last updated
07/11/2023
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