Healthcare Provider Details

I. General information

NPI: 1417593351
Provider Name (Legal Business Name): ATHENA C WEGGLER LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9959 SE DUNDEE DR
CLACKAMAS OR
97086-9730
US

IV. Provider business mailing address

9009 SE ADAMS ST UNIT 3136
CLACKAMAS OR
97015-1168
US

V. Phone/Fax

Practice location:
  • Phone: 971-208-5639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7210
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8914
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: