CHAD LEWIS MENICOSY

PORTLAND, OR
NPI1871126250
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101Y00000X Counselor
Additional Taxonomies372600000X Adult Companion
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2020-02-13
Last Update Date2021-04-06
Business Address
CHAD LEWIS MENICOSY
13541 SE MARKET ST
PORTLAND, OR 97233-1752
Phone number: 503-258-9734
Mailing Address
CHAD LEWIS MENICOSY
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number: 503-238-0769