Provider Demographics
NPI:1235540444
Name:DUMAN, CARL JAMES
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:JAMES
Last Name:DUMAN
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 1:13262 SW COMMONWEALTH LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0834
Mailing Address - Country:US
Mailing Address - Phone:503-380-6963
Mailing Address - Fax:
Practice Address - Street 1:110 COLUMBIA ST
Practice Address - Street 2:#106
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3512
Practice Address - Country:US
Practice Address - Phone:503-380-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20221041C0700X
WALW000065251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical