Provider Demographics
NPI:1982173589
Name:GEARY, PRENTICE (CADC III, QMHA)
Entity Type:Individual
Prefix:
First Name:PRENTICE
Middle Name:
Last Name:GEARY
Suffix:
Gender:M
Credentials:CADC III, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BLANKENSHIP RD STE 128
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4187
Mailing Address - Country:US
Mailing Address - Phone:971-378-0367
Mailing Address - Fax:503-974-9679
Practice Address - Street 1:1800 BLANKENSHIP RD STE 128
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068
Practice Address - Country:US
Practice Address - Phone:971-378-0367
Practice Address - Fax:503-974-9679
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18-01-43101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)