Provider Demographics
NPI:1770989840
Name:MILLIGAN, GORDON D (CADC I)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:D
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3715
Mailing Address - Country:US
Mailing Address - Phone:503-335-8611
Mailing Address - Fax:
Practice Address - Street 1:2318 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3715
Practice Address - Country:US
Practice Address - Phone:503-335-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-03-24320800000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)