Healthcare Provider Details

I. General information

NPI: 1619831054
Provider Name (Legal Business Name): AMBER ESTELLE LOGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 NE BAKER ST STE 260
MCMINNVILLE OR
97128-4950
US

IV. Provider business mailing address

609 NE BAKER ST STE 260
MCMINNVILLE OR
97128-4950
US

V. Phone/Fax

Practice location:
  • Phone: 971-318-0006
  • Fax:
Mailing address:
  • Phone: 971-318-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: