Healthcare Provider Details

I. General information

NPI: 1750439881
Provider Name (Legal Business Name): SHEILA DAWN SPAIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SW 2ND ST STE A
BEAVERTON OR
97005
US

IV. Provider business mailing address

14175 SW COUGAR RIDGE DR
BEAVERTON OR
97008-9419
US

V. Phone/Fax

Practice location:
  • Phone: 425-418-9515
  • Fax: 503-601-0049
Mailing address:
  • Phone: 425-418-9515
  • Fax: 503-601-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00001180
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1127
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: