Provider Demographics
NPI:1558633032
Name:WEBER, STEPHEN CHRISTIAN (BA, QMHA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTIAN
Last Name:WEBER
Suffix:
Gender:M
Credentials:BA, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N HAYDEN ISLAND DR
Mailing Address - Street 2:#112E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-8278
Mailing Address - Country:US
Mailing Address - Phone:503-317-2883
Mailing Address - Fax:
Practice Address - Street 1:1501 N HAYDEN ISLAND DR
Practice Address - Street 2:#112E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-8278
Practice Address - Country:US
Practice Address - Phone:503-317-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker