MEDICARE: MS. KATIE MORRIS HENSON LPC, CADCII

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	18-R-42	OR
2	101YP2500X	Professional Counselor	2713	OK
3	101YP2500X	Professional Counselor	C5224	OR

General Provider Information

NPI Number	:	1235312968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATIE MORRIS HENSON LPC, CADCII

Provider Business Mailing Address
First Line	:	1516 SE GLENWOOD ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-5659
Country	:	US
Telephone Number	:	405-361-1153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 SE ALDER ST STE 301
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2400
Country	:	US
Telephone Number	:	503-731-7103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	10/08/2019

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