Provider Demographics
NPI:1699182733
Name:ALBARRAN MEDINA, LUIS M (CADC I, CRM)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:M
Last Name:ALBARRAN MEDINA
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 1:18210 E BURNSIDE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5343
Mailing Address - Country:US
Mailing Address - Phone:503-334-8544
Mailing Address - Fax:503-465-0165
Practice Address - Street 1:18210 E BURNSIDE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5343
Practice Address - Country:US
Practice Address - Phone:503-334-8544
Practice Address - Fax:503-465-0165
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-09-02101YA0400X
OR15-PRC-009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor