Provider Demographics
NPI:1861829533
Name:DORFNER, JOSH MARTIN (MA, QMHP)
Entity Type:Individual
Prefix:MR
First Name:JOSH
Middle Name:MARTIN
Last Name:DORFNER
Suffix:
Gender:M
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 RAFFON CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-6063
Mailing Address - Country:US
Mailing Address - Phone:503-440-3680
Mailing Address - Fax:
Practice Address - Street 1:15544 S CLACKAMAS RIVER RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9490
Practice Address - Country:US
Practice Address - Phone:503-588-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health