Healthcare Provider Details

I. General information

NPI: 1972065571
Provider Name (Legal Business Name): C.H.E.R.I.I.S.H. COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN AVE STE 201D
GRESHAM OR
97030-7242
US

IV. Provider business mailing address

4233 SE 182ND AVE # 212
GRESHAM OR
97030-5082
US

V. Phone/Fax

Practice location:
  • Phone: 971-220-2496
  • Fax:
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALYCIA SMITH
Title or Position: MEMBER/THERAPIST
Credential:
Phone: 971-220-2496