Provider Demographics
NPI:1902950587
Name:CROSBY, PETER BARRETT (BS QMHA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BARRETT
Last Name:CROSBY
Suffix:
Gender:M
Credentials:BS QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 SE REEDWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5127
Mailing Address - Country:US
Mailing Address - Phone:360-430-3956
Mailing Address - Fax:
Practice Address - Street 1:7003 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5940
Practice Address - Country:US
Practice Address - Phone:503-402-8107
Practice Address - Fax:503-771-2728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator