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General NPI Number Information
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NPI Number | 1508716275
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Entity Type | Organization
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Legal Business Name | KALLIE COTHERN LLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 7619 N ALBINA AVE
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City | PORTLAND
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State | OR
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Zip | 97217-1307
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Country | US
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Telephone | 503-662-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 7619 N ALBINA AVE
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City | PORTLAND
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State | OR
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Zip | 97217-1307
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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 | PROVIDER/OWNER
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Name | KALLIE COTHERN
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Credential |
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Telephone | 503-662-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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