Provider Demographics
NPI:1548773963
Name:GUEVARA-MYERS, MARIBEL
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:GUEVARA-MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12239 SW STEAMBOAT DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7081
Mailing Address - Country:US
Mailing Address - Phone:641-328-3690
Mailing Address - Fax:
Practice Address - Street 1:4445 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4047
Practice Address - Country:US
Practice Address - Phone:503-768-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor