Mark Anthony Halloran Jr., PSS CRM QMHAR CADCR
Case Manager/Care Coordinator in Portland, OR. Individual provider (NPI-1).
NPI number1710693544
StatusActive
Last updated in NPPESFeb 10, 2025
Details
- NPI
- 1710693544
- Entity type
- Individual (NPI-1)
- Name
- Mark Anthony Halloran Jr.
- Credential
- PSS CRM QMHAR CADCR
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 25, 2023
- Certification date
- Feb 10, 2025
- Last updated
- Feb 10, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171M00000X | Case Manager/Care Coordinator | 24-QMHA-R6242 | OR | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | T-24-4760 | OR | |
| 175T00000X | Peer Specialist | 000106008 | OR |
Practice location
5415 Sw Westgate DrPortland, OR 97221-2409
Phone 971-727-8026
Mailing address
5415 Sw Westgate DrPortland, OR 97221-2409
Phone 971-727-8026
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