| Doctor Name: | GORDON SPATH |
| NPI Number: | 1124486774 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRM, PSS,ORO |
| License Number: | 15-CRM-063 |
| Business Practice Address: | 5030 Broadway St Apt 14 West Linn, OR - 970683365 |
| Business Phone Number: | 5033170572 |
| Business Fax Number: | |
| Mailing Address: | 5030 Broadway St Apt 14, WEST LINN |
| State: | OR |
| Postal Code: | 970683365 |
| Phone Number: | 5033170572 |
| Fax Number: | |
| NPI Enumeration Date: | 02/10/2016 |
| NPI Last Update Date: | 02/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 15-CRM-063 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |