MR. BRADLEY PAUL ROAN EAGLE NPI 1497393425

NPI Information

  • NPI: 1497393425
  • Provider Name: MR. BRADLEY PAUL ROAN EAGLE
  • Classification: Counselor - 101YA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Individual
  • Address: 3425 13TH ST
    BAKER CITY, OR
    ZIP 97814
  • Phone: (605) 516-0083

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NPI Details

MR. Bradley Paul Roan Eagle is an addiction (substance use disorder) counselor in Baker City, OR. MR. Bradley Paul Roan Eagle NPI is 1497393425. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3425 13TH ST
BAKER CITY, OR
ZIP 97814-340
Phone: (605) 516-0083

The enumeration date for this NPI number is 12/20/2019 and was last updated on 11/17/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1171M00000XCase Manager/Care Coordinator20-QMHA-R-0842OREGONNo
2175T00000XPeer Specialist21-CRM-411OREGONNo
3101YA0400XCounselorAddiction (Substance Use Disorder)T-20-486OREGONYes
4101YA0400XCounselorAddiction (Substance Use Disorder)CADC-RT-20-486OREGONNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
121-CRM-411OTHEROREGONCRM CERTIFICATE - MHACBO
250079031MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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