Provider Demographics
NPI:1578606935
Name:WELBES, MYRON JOHN (CADC I, CRM)
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:JOHN
Last Name:WELBES
Suffix:
Gender:M
Credentials:CADC I, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17036 S EADEN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-8673
Mailing Address - Country:US
Mailing Address - Phone:503-915-9110
Mailing Address - Fax:
Practice Address - Street 1:17663 SE 82ND DRIVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027
Practice Address - Country:US
Practice Address - Phone:503-344-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-CRM-075175T00000X
OR06-07-48101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)