Provider Demographics
NPI:1649558677
Name:KOLBA, GNIEWOSZ PAUL (MA, QMHP)
Entity type:Individual
Prefix:
First Name:GNIEWOSZ
Middle Name:PAUL
Last Name:KOLBA
Suffix:
Gender:M
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:KOLBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, QMHP
Mailing Address - Street 1:111 SW 5TH AVE
Mailing Address - Street 2:SUITE 3150
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3604
Mailing Address - Country:US
Mailing Address - Phone:503-765-5274
Mailing Address - Fax:
Practice Address - Street 1:111 SW 5TH AVE
Practice Address - Street 2:SUITE 3150
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3604
Practice Address - Country:US
Practice Address - Phone:971-533-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health