Provider Demographics
NPI:1164097986
Name:RUNNING, MICHAEL (MS, NCC, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RUNNING
Suffix:
Gender:M
Credentials:MS, NCC, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 SE HAWTHORNE BLVD # 315
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5048
Mailing Address - Country:US
Mailing Address - Phone:503-442-3563
Mailing Address - Fax:
Practice Address - Street 1:6124 SE MILWAUKIE AVE STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5347
Practice Address - Country:US
Practice Address - Phone:503-683-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional