Provider Demographics
NPI:1598773608
Name:BINKS, MICHAEL GLADE (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GLADE
Last Name:BINKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 SE MALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3573
Mailing Address - Country:US
Mailing Address - Phone:503-704-0573
Mailing Address - Fax:
Practice Address - Street 1:1817 NE 17TH AVE
Practice Address - Street 2:SAMARITAN COUNSELING CENTER MAIN OFFICE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-4509
Practice Address - Country:US
Practice Address - Phone:503-281-3318
Practice Address - Fax:503-281-0937
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1884101YM0800X, 101YP2500X
OR061188U3101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271177Medicaid
1235164559Medicare UPIN
OR0000WCBBCMedicare ID - Type Unspecified