Provider Demographics
NPI:1659106243
Name:MIERS, CONNOR GEORGE
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:GEORGE
Last Name:MIERS
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 1:16055 SW WALKER RD # 443
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4942
Mailing Address - Country:US
Mailing Address - Phone:503-828-3402
Mailing Address - Fax:503-828-3401
Practice Address - Street 1:16365 NW TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-828-3402
Practice Address - Fax:503-828-3401
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health