Holderbach, Mark Edward
Holderbach, Mark Edward is an individual health care provider with primary practice located at 4101 Ne Division St , Gresham OR 97030-4617. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Holderbach, Mark Edward can be contacted via phone (503) 666-6575.Contact Information
Primary practice address
4101 Ne Division St
Gresham OR 97030-4617
Phone: (503) 666-6575
Fax: (503) 666-4047
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | L3497 | Oregon |
Profile Details
| NPI number | 1649397183 |
|---|---|
| LBN Legal business name | Holderbach, Mark Edward |
| Credentials | M.S.W., L.C.S.W. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 22nd, 2007 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649397183 | NPPES |
| Oregon | MEDICAID | 1041C0700X CLINICAL |
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