Healthcare Provider Details

I. General information

NPI: 1730792292
Provider Name (Legal Business Name): MICHELE EAVE PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 SW BARNES RD
PORTLAND OR
97225-6619
US

IV. Provider business mailing address

28748 SW FINLAND AVE
WILSONVILLE OR
97070-7115
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-2025
  • Fax:
Mailing address:
  • Phone: 503-847-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC2511
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: