Healthcare Provider Details

I. General information

NPI: 1144072885
Provider Name (Legal Business Name): GHASSAN AMMAR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 N LOMBARD ST STE 1
PORTLAND OR
97203-3156
US

IV. Provider business mailing address

10350 N VANCOUVER WAY # 5338
PORTLAND OR
97217-7530
US

V. Phone/Fax

Practice location:
  • Phone: 503-941-0359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GHASSAN AMMAR
Title or Position: OWNER
Credential: LPC
Phone: 503-941-0359