Healthcare Provider Details

I. General information

NPI: 1427047927
Provider Name (Legal Business Name): KATHLEEN MARIE LOVE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SW MARLOW AVE STE 303
PORTLAND OR
97225-5102
US

IV. Provider business mailing address

8923 SW MARSEILLES DR
BEAVERTON OR
97007-9040
US

V. Phone/Fax

Practice location:
  • Phone: 503-807-2704
  • Fax: 503-296-2276
Mailing address:
  • Phone: 503-807-2704
  • Fax: 503-296-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3805
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: