Healthcare Provider Details

I. General information

NPI: 1144428434
Provider Name (Legal Business Name): ELAINE J. DAVIS LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2007
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NW STUCKI PL STE 230
HILLSBORO OR
97124-7328
US

IV. Provider business mailing address

3000 NW STUCKI PL STE 230
HILLSBORO OR
97124-7328
US

V. Phone/Fax

Practice location:
  • Phone: 503-402-8654
  • Fax: 503-645-0822
Mailing address:
  • Phone: 503-402-8654
  • Fax: 503-645-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2536
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberTO755
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: