Provider Demographics
NPI:1891893269
Name:ALTIG, JOSE L (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:ALTIG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 NE 218TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-7738
Mailing Address - Country:US
Mailing Address - Phone:503-666-1060
Mailing Address - Fax:
Practice Address - Street 1:3616 NE 218TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-7738
Practice Address - Country:US
Practice Address - Phone:503-666-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health