Provider Demographics
NPI:1053658807
Name:KOLBA, PHILIP (MA LPC NCC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:KOLBA
Suffix:
Gender:M
Credentials:MA LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 SW 3RD AVE STE 221-9687
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2405
Mailing Address - Country:US
Mailing Address - Phone:503-987-0337
Mailing Address - Fax:503-388-3082
Practice Address - Street 1:818 SW 3RD AVE STE 221-9687
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2405
Practice Address - Country:US
Practice Address - Phone:503-987-0337
Practice Address - Fax:503-388-3082
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health