Healthcare Provider Details

I. General information

NPI: 1255903241
Provider Name (Legal Business Name): OLIVIA T CRAINE ATRP, PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIV CRAINE

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW EASTRIDGE ST
PORTLAND OR
97225-5004
US

IV. Provider business mailing address

4107 SE GLADSTONE ST APT 1
PORTLAND OR
97202-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-944-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number25-304
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR11572
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: