Provider Demographics
NPI:1760875777
Name:COONS, BECKY (CADC I CANDIDATE)
Entity Type:Individual
Prefix:MISS
First Name:BECKY
Middle Name:
Last Name:COONS
Suffix:
Gender:F
Credentials:CADC I CANDIDATE
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:RUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 E. BURNSIDE ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-239-8400
Mailing Address - Fax:503-269-8407
Practice Address - Street 1:10362 SW MCDONALD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:503-624-0312
Practice Address - Fax:503-639-3973
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)