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General NPI Number Information
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NPI Number | 1801668355
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Entity Type | Organization
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Legal Business Name | CONCINNITY THERAPY LLC
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 3407 S CORBETT AVE # 7
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City | PORTLAND
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State | OR
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Zip | 97239-4621
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Country | US
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Telephone | 503-208-4687
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Fax |
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Provider Business Mailing Address
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Address Line | 3407 S CORBETT AVE # 7
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City | PORTLAND
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State | OR
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Zip | 97239-4621
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Country | US
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Telephone | 503-208-4687
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | KAREN ANDAL NERI
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Credential | JD, MA
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Telephone | 503-208-4687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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