Provider Demographics
NPI:1528744042
Name:CONACHAN, GARY STEVEN III (MS, NCC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEVEN
Last Name:CONACHAN
Suffix:III
Gender:M
Credentials:MS, NCC
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Other - Credentials:
Mailing Address - Street 1:2521 SE 25TH AVE.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-410-3074
Mailing Address - Fax:
Practice Address - Street 1:7316 SE 87TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-5732
Practice Address - Country:US
Practice Address - Phone:971-303-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health