Provider Demographics
NPI:1033730056
Name:MITCH ELOVITZ, LPC, LLC
Entity Type:Organization
Organization Name:MITCH ELOVITZ, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-804-3063
Mailing Address - Street 1:7766 SE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6209
Mailing Address - Country:US
Mailing Address - Phone:503-804-3063
Mailing Address - Fax:
Practice Address - Street 1:15100 BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3469
Practice Address - Country:US
Practice Address - Phone:503-804-3063
Practice Address - Fax:503-635-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty