Provider Demographics
NPI:1932532611
Name:CASWELL, CLARK (CADC II)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:CASWELL
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 SW HAMPTON ST
Mailing Address - Street 2:STE 109
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8329
Mailing Address - Country:US
Mailing Address - Phone:971-255-1513
Mailing Address - Fax:
Practice Address - Street 1:6950 SW HAMPTON ST
Practice Address - Street 2:STE 109
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8329
Practice Address - Country:US
Practice Address - Phone:971-255-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00-07-05101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)