Healthcare Provider Details

I. General information

NPI: 1851526024
Provider Name (Legal Business Name): CATHERINE ANNE CUPP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SW GRIFFITH DR STE 235
BEAVERTON OR
97005-4649
US

IV. Provider business mailing address

13570 SW 6TH ST
BEAVERTON OR
97005-3869
US

V. Phone/Fax

Practice location:
  • Phone: 541-377-9011
  • Fax: 503-526-3812
Mailing address:
  • Phone: 541-377-9011
  • Fax: 503-526-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1182
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: