Basic Information
| Provider Information | |||||||||
| NPI: | 1497064042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BETTERTON SHELMET | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | ANN | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | BETTERTON | ||||||||
| OtherFirstName: | ADRIENNE | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 727 NE 24TH AVE | ||||||||
| Address2: | VOLUNTEERS OF AMERICA INACT | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032289229 | ||||||||
| FaxNumber: | 5032289558 | ||||||||
| Practice Location | |||||||||
| Address1: | 727 NE 24TH AVE | ||||||||
| Address2: | VOLUNTEERS OF AMERICA INACT | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032289229 | ||||||||
| FaxNumber: | 5032289558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2010 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.