Skip Navigation

Provider Information for 1568852655

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1568852655

Calendar   Last Updated:  2021-01-20
  Certification Date:  2021-01-20


Name Value
NPI 1568852655
Enumeration Date 2015-01-28
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 7835 SW 82ND AVE
PORTLAND, OR 97223-7328
United States

Phone: 979-450-3980 | Fax:
View Map External Link
Primary Practice Address 847 NE 19TH AVE STE 100
United States

Phone: 503-238-0769 | Fax:
View Map External Link
Secondary Practice Address 10564 SE WASHINGTON ST
PORTLAND, OR 97216-2809
United States

Phone: 503-228-9229 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 101YA0400X - Counselor Addiction (Substance Use Disorder)
No 101YM0800X - Counselor Mental Health