Provider Demographics
NPI:1033490305
Name:HARTNETT BORUFF, KATHRYN A (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:HARTNETT BORUFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 N WALL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5154
Mailing Address - Country:US
Mailing Address - Phone:312-909-7152
Mailing Address - Fax:
Practice Address - Street 1:610 SW ALDER ST STE 1100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3612
Practice Address - Country:US
Practice Address - Phone:312-909-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007517101YM0800X
ORC4581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health