Healthcare Provider Details

I. General information

NPI: 1194433250
Provider Name (Legal Business Name): CONNECTED SPACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 NE HOOD AVE
GRESHAM OR
97030-7328
US

IV. Provider business mailing address

PO BOX 1245
SANDY OR
97055-1245
US

V. Phone/Fax

Practice location:
  • Phone: 971-404-4688
  • Fax: 971-273-2708
Mailing address:
  • Phone: 971-404-4668
  • Fax: 971-273-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: FRANCES LEANNE CLARK
Title or Position: OWNER
Credential: MA, LPC
Phone: 503-444-1190