Healthcare Provider Details

I. General information

NPI: 1356181424
Provider Name (Legal Business Name): TWO SPARROWS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 696-3
BEAVERTON OR
97005-3019
US

IV. Provider business mailing address

15240 SW LARK LN
BEAVERTON OR
97007-6100
US

V. Phone/Fax

Practice location:
  • Phone: 360-600-5877
  • Fax:
Mailing address:
  • Phone: 360-600-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY ANN MCCLUNG
Title or Position: OWNER/PROVIDER
Credential: LPC, LMFT
Phone: 360-600-5877