Provider Demographics
NPI:1982431110
Name:CUBBEDGE, HAROLD REICHERT (CADC-I, PWS, CRM)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:REICHERT
Last Name:CUBBEDGE
Suffix:
Gender:M
Credentials:CADC-I, PWS, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6891
Mailing Address - Country:US
Mailing Address - Phone:971-971-9777
Mailing Address - Fax:
Practice Address - Street 1:6310 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-6891
Practice Address - Country:US
Practice Address - Phone:971-971-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-12-10976101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)