Provider Demographics
NPI:1114329356
Name:MCGEE, FRED L III (CRM, CADC I)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:L
Last Name:MCGEE
Suffix:III
Gender:M
Credentials:CRM, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 NE TENNY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9179
Mailing Address - Country:US
Mailing Address - Phone:503-975-6082
Mailing Address - Fax:
Practice Address - Street 1:16111 E BURNSIDE ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-3519
Practice Address - Country:US
Practice Address - Phone:503-975-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-CRM-042175T00000X
OR14-06-08101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist