Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane Anthony Gonzales, CRM

Individual provider Substance Use Disorder Rehabilitation Clinic/Center · NPI 1245065366

Shane Anthony Gonzales, CRM is a Substance Use Disorder Rehabilitation Clinic/Center in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2024

Practice location Address checks out

1122 NE 122nd Ave Ste A200
Portland, OR 97230-2083
Phone: (503) 594-4774
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Substance Use Disorder Rehabilitation Clinic/Center (primary) Taxonomy 261QR0405X (OR)

Record details

NPI number1245065366
Entity typeIndividual (Type 1)
GenderMale
Credentials CRM
Sole proprietorYes
NPI enumeratedSeptember 6, 2024
Last updated in NPPESSeptember 6, 2024
Certification dateSeptember 6, 2024
Mailing address1122 Ne 122nd Ave Ste A200, Portland, OR 97230-2083

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