MEDICARE: MS. EMELIE ANGELINA DOUGLAS MA, LPC

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	101Y00000X	Counselor	C5035	OR

General Provider Information

NPI Number	:	1467821199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMELIE ANGELINA DOUGLAS MA, LPC

Provider Business Mailing Address
First Line	:	9133 N ALLEGHENY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-2303
Country	:	US
Telephone Number	:	971-319-4827
Fax Number	:	503-662-6221

Provider Business Practice Location Address
First Line	:	9133 N ALLEGHENY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-2303
Country	:	US
Telephone Number	:	971-319-4827
Fax Number	:	503-662-6221

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	03/18/2026

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