Provider Demographics
NPI:1013509041
Name:BLUETT, PATRICK TYLER
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:TYLER
Last Name:BLUETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 SE MARTHA CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6064
Mailing Address - Country:US
Mailing Address - Phone:503-730-7478
Mailing Address - Fax:
Practice Address - Street 1:8083 SE 13TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6668
Practice Address - Country:US
Practice Address - Phone:971-350-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6279101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor