Provider Demographics
NPI:1114495371
Name:THERAPY EXPERIENCED
Entity Type:Organization
Organization Name:THERAPY EXPERIENCED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-266-4444
Mailing Address - Street 1:2350 SE TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-9732
Mailing Address - Country:US
Mailing Address - Phone:503-266-4444
Mailing Address - Fax:503-266-7659
Practice Address - Street 1:2350 SE TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-9732
Practice Address - Country:US
Practice Address - Phone:503-266-4444
Practice Address - Fax:503-266-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty