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General NPI Number Information
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NPI Number | 1821276411
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Entity Type | Organization
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Legal Business Name | FIFTH AVENUE COUNSELING & CONSULTING
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1312 SW 16TH AVE #103
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City | PORTLAND
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State | OR
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Zip | 97201-2516
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Country | US
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Telephone | 503-295-7974
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Fax | 503-295-3727
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Provider Business Mailing Address
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Address Line | 1312 SW 16TH AVE #103
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City | PORTLAND
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State | OR
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Zip | 97201-2516
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Country | US
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Telephone | 503-295-7974
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Fax | 503-295-3727
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. PETER BARBUR
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Credential | LPC
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Telephone | 503-295-7974
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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 | C1784
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C2116
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C0630
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License Number State | OR
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