Healthcare Provider Details

I. General information

NPI: 1225417033
Provider Name (Legal Business Name): KATIE LOUISE KOTSOVOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14925 SW BARROWS RD STE 109 #143
BEAVERTON OR
97007
US

IV. Provider business mailing address

14925 SW BARROWS RD STE 109 #143
BEAVERTON OR
97007
US

V. Phone/Fax

Practice location:
  • Phone: 503-454-6904
  • Fax:
Mailing address:
  • Phone: 503-454-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5925
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: