Provider Demographics
NPI:1225487127
Name:LAIR, JOSH (CRM)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:LAIR
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 HAROLD DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1339
Mailing Address - Country:US
Mailing Address - Phone:503-399-5597
Mailing Address - Fax:503-316-9740
Practice Address - Street 1:863 LIBERTY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2451
Practice Address - Country:US
Practice Address - Phone:503-399-5597
Practice Address - Fax:503-316-9740
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
OR16-CRM-070101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR263634042Medicaid