Healthcare Provider Details

I. General information

NPI: 1144124553
Provider Name (Legal Business Name): CREATING BALANE PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 SE 75TH AVE
PORTLAND OR
97206-1822
US

IV. Provider business mailing address

3116 SE 75TH AVE
PORTLAND OR
97206-1822
US

V. Phone/Fax

Practice location:
  • Phone: 971-344-3040
  • Fax:
Mailing address:
  • Phone: 971-344-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMUEL CHI BAKER
Title or Position: OWNER
Credential: LPC
Phone: 971-344-3040