Healthcare Provider Details

I. General information

NPI: 1437523461
Provider Name (Legal Business Name): CHANEL WALKER-HARRIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHANEL WALKER

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW DIVISION ST
GRESHAM OR
97030-5292
US

IV. Provider business mailing address

1231 NE M L KING BLVD APT 304
PORTLAND OR
97232-2094
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-8145
  • Fax:
Mailing address:
  • Phone: 318-518-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5372
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: