Provider Demographics
NPI:1144779893
Name:COHEN, KERRY (COUNSELOR)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NE HOLLADAY ST
Mailing Address - Street 2:STE 1685
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2045
Mailing Address - Country:US
Mailing Address - Phone:503-757-1606
Mailing Address - Fax:
Practice Address - Street 1:650 NE HOLLADAY ST
Practice Address - Street 2:STE 1685
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2045
Practice Address - Country:US
Practice Address - Phone:503-757-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3461101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor