Healthcare Provider Details

I. General information

NPI: 1114557485
Provider Name (Legal Business Name): KHATYA ALBANO MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SE ALDER ST STE 301
PORTLAND OR
97214-2400
US

IV. Provider business mailing address

2021 SE OAK ST APT 3
PORTLAND OR
97214-1668
US

V. Phone/Fax

Practice location:
  • Phone: 562-999-1449
  • Fax:
Mailing address:
  • Phone: 562-999-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114506
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2485
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: