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General NPI Number Information
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NPI Number | 1134267875
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Entity Type | Individual
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Provider Name | KATHERINE ELOUISE BENTLEY MSW, LCSW, CADC I
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 3550 N INTERSTATE AVE
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City | PORTLAND
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State | OR
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Zip | 97227-1196
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Country | US
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Telephone | 503-249-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 SE WOODSTOCK BLVD # 164
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City | PORTLAND
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State | OR
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Zip | 97206-6267
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Country | US
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Telephone | 503-758-3750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 04-07-01
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | L4693
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License Number State | OR
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