Provider Demographics
NPI:1609260801
Name:SYREK, SEAN M (PWS, PRC, CADC I)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:SYREK
Suffix:
Gender:M
Credentials:PWS, PRC, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373 NE HANCOCK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3894
Mailing Address - Country:US
Mailing Address - Phone:971-337-4834
Mailing Address - Fax:
Practice Address - Street 1:10373 NE HANCOCK ST STE 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3894
Practice Address - Country:US
Practice Address - Phone:971-337-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-CRM-022175T00000X
ORTHW0263175T00000X
OR16-PRC-004175T00000X
OR18-03-25101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist