Provider Demographics
NPI:1982707915
Name:GARNER, PATRICIA (CADC QMHP MED)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:CADC QMHP MED
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC QMHP MED
Mailing Address - Street 1:2405 SE 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5923
Mailing Address - Country:US
Mailing Address - Phone:503-236-7347
Mailing Address - Fax:
Practice Address - Street 1:131 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4167
Practice Address - Country:US
Practice Address - Phone:503-253-6754
Practice Address - Fax:503-251-1344
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
950441101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health