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General NPI Number Information
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NPI Number | 1225565583
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Entity Type | Organization
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Legal Business Name | CIRCLE OF HEALING COUNSELING LLC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 05/18/2017
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Provider Practice Location Address
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Address Line | 5819 N GREELEY AVE STE 102
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City | PORTLAND
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State | OR
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Zip | 97217-4159
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Country | US
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Telephone | 503-901-5798
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Fax |
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Provider Business Mailing Address
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Address Line | 5819 N GREELEY AVE STE 102
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City | PORTLAND
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State | OR
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Zip | 97217-4159
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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 | LCSW, THERAPIST, MEMBER
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Name | LAUREN PEREZ
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Credential | LCSW
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Telephone | 503-901-5798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | L4805
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L4805
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License Number State | OR
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