Provider Demographics
NPI:1063688356
Name:STORM, ROBIN LORRAINE (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LORRAINE
Last Name:STORM
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 SW CANYON TER APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3624
Mailing Address - Country:US
Mailing Address - Phone:503-957-4952
Mailing Address - Fax:
Practice Address - Street 1:8835 SW CANYON LN
Practice Address - Street 2:SUITE 234
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3443
Practice Address - Country:US
Practice Address - Phone:503-957-4952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 171M00000X
ORC3802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator