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1194147223
FREDERICK BERRY
PORTLAND, OR
NPI
1194147223
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
Enumeration Date
2014-01-08
Last Update Date
2014-01-08
Business Address
FREDERICK BERRY
3034 NE MLK BLVD
PORTLAND, OR 97212-3053
Phone number: 503-238-3763
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Mailing Address
FREDERICK BERRY
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number: 503-238-0769
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