Roan Eagle, Bradley Paul

Roan Eagle, Bradley Paul is an individual health care provider with primary practice located at 3425 13Th St , Baker City OR 97814-1340. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Other Service Providers / Case Manager/Care Coordinator. Other Service Providers / Peer Specialist is his primary health care specialty. Roan Eagle, Bradley Paul can be contacted via phone (605) 516-0083.

Contact Information

Primary practice address
3425 13Th St Baker City OR 97814-1340
Phone: (605) 516-0083
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X 21-CRM-411 Oregon
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CADC-RT-20-486 Oregon
Other Service Providers / Case Manager/Care Coordinator 171M00000X 20-QMHA-R-0842 Oregon

Profile Details

NPI number 1497393425
LBN Legal business name Roan Eagle, Bradley Paul
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 20th, 2019
Last updated Apr 8th, 2021 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497393425 NPPES
Oregon Other 21-CRM-411 CRM CERTIFICATE - MHACBO

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