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General NPI Number Information
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NPI Number | 1780518373
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Entity Type | Individual
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Provider Name | KOURTNEY LONG MAC, CADC 1, LPC-A
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Gender | Female
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 1901 N ESTHER ST
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City | NEWBERG
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State | OR
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Zip | 97132-9529
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Country | US
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Telephone | 877-357-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 11935 SW 176TH DR
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City | BEAVERTON
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State | OR
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Zip | 97007-6118
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Country | US
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Telephone | 541-630-1542
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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 | 24-10-11272
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License Number State | OR
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