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General NPI Number Information
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NPI Number | 1174023808
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Entity Type | Organization
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Legal Business Name | BLAKE LOCHER COUNSELING, LLC
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 1020 SW TAYLOR ST STE 449
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City | PORTLAND
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State | OR
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Zip | 97205-2556
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Country | US
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Telephone | 971-279-7484
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 SW TAYLOR ST STE 449
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City | PORTLAND
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State | OR
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Zip | 97205-2556
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | BLAKE WAYSON LOCHER
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Credential | MS, CRC, LPCI
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Telephone | 971-279-7484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | R3805
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License Number State | OR
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