Provider Demographics
NPI:1811388218
Name:LANGFORD, SHAWN (CADC I)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-224-4494
Practice Address - Street 1:1776 SW MADISON ST
Practice Address - Street 2:PORTLAND
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1715
Practice Address - Country:US
Practice Address - Phone:503-244-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-04-07101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)