Provider Demographics
NPI:1164916060
Name:STEIN, CRAIG
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 NE 21ST AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1537
Mailing Address - Country:US
Mailing Address - Phone:503-502-2028
Mailing Address - Fax:
Practice Address - Street 1:5441 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1837
Practice Address - Country:US
Practice Address - Phone:503-502-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral