Provider Demographics
NPI:1215071782
Name:WOMACK-MEYER, BRANDON PAUL (BS, CADC I, QHMA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:PAUL
Last Name:WOMACK-MEYER
Suffix:
Gender:M
Credentials:BS, CADC I, QHMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 NW EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3517
Mailing Address - Country:US
Mailing Address - Phone:503-226-4060
Mailing Address - Fax:
Practice Address - Street 1:709 NW EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3517
Practice Address - Country:US
Practice Address - Phone:503-226-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-12-69101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12-12-69OtherADDICTION COUNSELOR CERTIFICATION BOARD OF OREGON