Provider Demographics
NPI:1225564180
Name:STROUGHTER, REGINAL (CRM, CGAC1, CADC1 AP)
Entity Type:Individual
Prefix:
First Name:REGINAL
Middle Name:
Last Name:STROUGHTER
Suffix:
Gender:M
Credentials:CRM, CGAC1, CADC1 AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10564 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2809
Mailing Address - Country:US
Mailing Address - Phone:503-888-6065
Mailing Address - Fax:503-228-9558
Practice Address - Street 1:5257 NE MARTIN LUTHER KING JR STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3283
Practice Address - Country:US
Practice Address - Phone:503-676-3710
Practice Address - Fax:503-430-5403
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OR12-CRM-046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)