Basic Information
| Provider Information | |||||||||
| NPI: | 1225564180 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STROUGHTER | ||||||||
| FirstName: | REGINAL | ||||||||
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| Credential: | CRM, CGAC1, CADC1 AP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10564 SE WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038886065 | ||||||||
| FaxNumber: | 5032289558 | ||||||||
| Practice Location | |||||||||
| Address1: | 5257 NE MARTIN LUTHER KING JR STE 201 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972113283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036763710 | ||||||||
| FaxNumber: | 5034305403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 12-CRM-046 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.