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1306204193
ANDREW BLACK
PORTLAND, OR
NPI
1306204193
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2016-02-08
Last Update Date
2016-02-08
Business Address
ANDREW BLACK
17640 NE HALSEY ST
PORTLAND, OR 97230-6733
Phone number: 503-489-5045
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Mailing Address
ANDREW BLACK
3587 HEATHROW WAY
MEDFORD, OR 97504-4004
Phone number: 503-913-9656
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