Provider Demographics
NPI:1316464910
Name:DEVLIN, PATRICK BRIAN JR (LCSW, CADC II)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:BRIAN
Last Name:DEVLIN
Suffix:JR
Gender:M
Credentials:LCSW, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10258 WAGNER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-7807
Mailing Address - Country:US
Mailing Address - Phone:972-741-7400
Mailing Address - Fax:
Practice Address - Street 1:731 NW FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2752
Practice Address - Country:US
Practice Address - Phone:541-306-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-03-57101YA0400X
ORL67421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)