Provider Demographics
NPI:1144545187
Name:MEIFFREN, MICHEL R (MA, MAC, CADC I)
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:R
Last Name:MEIFFREN
Suffix:
Gender:M
Credentials:MA, MAC, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 4TH ST
Mailing Address - Street 2:# 2
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4359
Mailing Address - Country:US
Mailing Address - Phone:503-338-8106
Mailing Address - Fax:
Practice Address - Street 1:185 4TH ST
Practice Address - Street 2:# 2
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4359
Practice Address - Country:US
Practice Address - Phone:503-338-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-09-32101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)