Healthcare Provider Details

I. General information

NPI: 1518376581
Provider Name (Legal Business Name): AMY SWALLOW LPC, LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 SE FOSTER RD
PORTLAND OR
97206-2936
US

IV. Provider business mailing address

4207 SE WOODSTOCK BLVD # 361
PORTLAND OR
97206-6267
US

V. Phone/Fax

Practice location:
  • Phone: 503-312-6005
  • Fax:
Mailing address:
  • Phone: 503-312-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberART-C-10205600
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4192
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC4192
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4192
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: