Provider Demographics
NPI:1689093130
Name:PATTERSON, GARY H (CADC III, MSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:H
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:CADC III, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 SW GREENBURG RD STE 601
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5429
Mailing Address - Country:US
Mailing Address - Phone:503-836-2228
Mailing Address - Fax:971-888-4065
Practice Address - Street 1:9370 SW GREENBURG RD STE 601
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5429
Practice Address - Country:US
Practice Address - Phone:503-836-2228
Practice Address - Fax:971-888-4065
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00-R-01101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)