Healthcare Provider Details

I. General information

NPI: 1255642617
Provider Name (Legal Business Name): ELIZABETH BOLES-DREYFUS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 SW BOONES FERRY RD STE 100
TUALATIN OR
97062-8607
US

IV. Provider business mailing address

847 NE 19TH AVE
PORTLAND OR
97232-2684
US

V. Phone/Fax

Practice location:
  • Phone: 503-612-1000
  • Fax:
Mailing address:
  • Phone: 503-645-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8547
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: