Healthcare Provider Details

I. General information

NPI: 1962286765
Provider Name (Legal Business Name): RACHEL HASSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N ELM ST
CANBY OR
97013-3519
US

IV. Provider business mailing address

825 NE 20TH AVE STE 225
PORTLAND OR
97232-2299
US

V. Phone/Fax

Practice location:
  • Phone: 503-372-5147
  • Fax: 503-266-8632
Mailing address:
  • Phone: 503-433-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: