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NPI Code Detail

MEDICARE: SENUA COUNSELING CLINIC, LLC

MEDICARE: SENUA COUNSELING CLINIC, 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
1261QM0850XAdult Mental Health Clinic/Center
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902324122
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENUA COUNSELING CLINIC, LLC
Provider Business Mailing Address
First Line : 5300 PARKVIEW DR APT 1017
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-8723
Country : US
Telephone Number : 503-705-3009
Fax Number :
Provider Business Practice Location Address
First Line : 4800 MEADOWS RD STE 300
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-5277
Country : US
Telephone Number : 503-705-3009
Fax Number :
Authorized Official
Title or Position : OWNER/LEAD THERAPIST
Name : KELLIE COLLINS
Credential :
Telephone Number : 503-705-3009
Provider Enumeration Date : 09/07/2017
Last Update Date : 09/07/2017

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Directions to “SENUA COUNSELING CLINIC, LLC ” Practice Location

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