Healthcare Provider Details

I. General information

NPI: 1538836473
Provider Name (Legal Business Name): MARINA PARKER LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
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

18715 SW 91ST TER
TUALATIN OR
97062-7419
US

V. Phone/Fax

Practice location:
  • Phone: 503-612-1000
  • Fax:
Mailing address:
  • Phone: 503-702-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2464
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7161
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: