Provider Demographics
NPI:1043922271
Name:COLLECTIVE INSIGHT THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:COLLECTIVE INSIGHT THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCLEOUD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-212-0058
Mailing Address - Street 1:PO BOX 14614
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97293-0614
Mailing Address - Country:US
Mailing Address - Phone:971-393-6084
Mailing Address - Fax:
Practice Address - Street 1:516 SE MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2327
Practice Address - Country:US
Practice Address - Phone:541-212-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty