Provider Demographics
NPI:1629183736
Name:HARAM, GERALD MARK (MS)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:MARK
Last Name:HARAM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10163 SE SUNNYSIDE RD
Mailing Address - Street 2:STE 490
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5743
Mailing Address - Country:US
Mailing Address - Phone:503-513-4400
Mailing Address - Fax:
Practice Address - Street 1:10163 SE SUNNYSIDE RD
Practice Address - Street 2:STE 490
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5743
Practice Address - Country:US
Practice Address - Phone:503-513-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR C1266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health