MEDICARE: KALLIE COTHERN 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

General Provider Information

NPI Number	:	1508716275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALLIE COTHERN LLC

Provider Business Mailing Address
First Line	:	7619 N ALBINA AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7619 N ALBINA AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1307
Country	:	US
Telephone Number	:	503-662-8989
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	KALLIE COTHERN
Credential	:
Telephone Number	:	503-662-8989

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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