Provider Demographics
NPI:1437873916
Name:DEVINE, BRIAN JAMES
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:DEVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3711
Mailing Address - Country:US
Mailing Address - Phone:503-560-3368
Mailing Address - Fax:
Practice Address - Street 1:1235 SE MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2462
Practice Address - Country:US
Practice Address - Phone:503-376-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA15387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health