Provider Demographics
NPI:1043534084
Name:FINK, GARY (MA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FINK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NE SISKIYOU ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2471
Mailing Address - Country:US
Mailing Address - Phone:503-961-4279
Mailing Address - Fax:
Practice Address - Street 1:2330 NE SISKIYOU ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2471
Practice Address - Country:US
Practice Address - Phone:503-528-0757
Practice Address - Fax:503-528-0764
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health