Provider Demographics
NPI:1568870780
Name:INIGUEZ, JULIO (LMFT, CGACII, CADCI)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:INIGUEZ
Suffix:
Gender:M
Credentials:LMFT, CGACII, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2411
Mailing Address - Country:US
Mailing Address - Phone:503-803-2678
Mailing Address - Fax:
Practice Address - Street 1:5200 S MACADAM AVE STE 460
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3836
Practice Address - Country:US
Practice Address - Phone:503-803-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORG 130804101YA0400X
101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health