Provider Demographics
NPI:1487321659
Name:MOTEN, DUKE I (CADC II, QMHA-1)
Entity type:Individual
Prefix:
First Name:DUKE
Middle Name:
Last Name:MOTEN
Suffix:I
Gender:M
Credentials:CADC II, QMHA-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1650
Mailing Address - Country:US
Mailing Address - Phone:503-960-4741
Mailing Address - Fax:
Practice Address - Street 1:6025 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1927
Practice Address - Country:US
Practice Address - Phone:503-960-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00-03-30101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)