Healthcare Provider Details

I. General information

NPI: 1174026421
Provider Name (Legal Business Name): ALEXANDRA ANNE EMMERT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEX EMMERT LPC

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 82ND DR
GLADSTONE OR
97027-1803
US

IV. Provider business mailing address

880 82ND DR
GLADSTONE OR
97027-1803
US

V. Phone/Fax

Practice location:
  • Phone: 971-378-0367
  • Fax: 503-974-9679
Mailing address:
  • Phone: 971-378-0367
  • Fax: 503-974-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8005
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8005
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: