MEDICARE: PLAYFAIR CONSULTING, LLC

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	101YM0800X	Mental Health Counselor	C4080	OR

General Provider Information

NPI Number	:	1316300171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAYFAIR CONSULTING, LLC

Provider Business Mailing Address
First Line	:	4017 NE FLANDERS ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3323
Country	:	US
Telephone Number	:	503-610-6162
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 NE FLANDERS ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3323
Country	:	US
Telephone Number	:	503-610-6162
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL COUNSELOR AND CONSULTANT
Name	:	KATHRYN R PLAYFAIR
Credential	:	LPC
Telephone Number	:	510-910-2033

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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