Healthcare Provider Details

I. General information

NPI: 1457645962
Provider Name (Legal Business Name): CATHY OLBRICH-TENNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL ROAD VAMC/P35C
PORTLAND OR
97207
US

IV. Provider business mailing address

3710 SW US VETERANS HOSPITAL ROAD VAMC/P35C
PORTLAND OR
97207
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax: 503-273-5243
Mailing address:
  • Phone: 503-220-8262
  • Fax: 503-273-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3734
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: