Provider Demographics
NPI:1518482231
Name:MONSE, EVAN
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:MONSE
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 1:1035 SE 12TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2558
Mailing Address - Country:US
Mailing Address - Phone:503-454-6315
Mailing Address - Fax:
Practice Address - Street 1:1035 SE 12TH AVE APT 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2558
Practice Address - Country:US
Practice Address - Phone:503-454-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC9929101YM0800X
ORR7205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty