Provider Demographics
NPI:1013410034
Name:GOSSETT, JAMES (CADCII, NCACII)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GOSSETT
Suffix:
Gender:M
Credentials:CADCII, NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N EVEREST ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2116
Mailing Address - Country:US
Mailing Address - Phone:503-538-7647
Mailing Address - Fax:
Practice Address - Street 1:120 N EVEREST ST STE A
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2116
Practice Address - Country:US
Practice Address - Phone:503-538-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96-10-115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1665036OtherODL