Healthcare Provider Details

I. General information

NPI: 1801930011
Provider Name (Legal Business Name): KATRINA MARIA DE BOER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 SE WASHINGTON ST
HILLSBORO OR
97123-4141
US

IV. Provider business mailing address

10313 SW 69TH AVE
TIGARD OR
97223-9103
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-3814
  • Fax: 503-726-3815
Mailing address:
  • Phone: 503-726-3814
  • Fax: 503-726-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number06-11-15
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1915
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: