Provider Demographics
NPI:1134485063
Name:WEBER, CASEY SCOTT (LPC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:SCOTT
Last Name:WEBER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SW MORRISON ST
Mailing Address - Street 2:SUITE 929
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2235
Mailing Address - Country:US
Mailing Address - Phone:503-241-0466
Mailing Address - Fax:503-241-7971
Practice Address - Street 1:1220 SW MORRISON ST
Practice Address - Street 2:SUITE 929
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2235
Practice Address - Country:US
Practice Address - Phone:503-241-0466
Practice Address - Fax:503-241-7971
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional