Provider Demographics
NPI:1205390739
Name:MOSER, CHERYLYNN ANDRES (LPC, LAT)
Entity Type:Individual
Prefix:
First Name:CHERYLYNN
Middle Name:ANDRES
Last Name:MOSER
Suffix:
Gender:F
Credentials:LPC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD STE 634
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6632
Mailing Address - Country:US
Mailing Address - Phone:503-216-6662
Mailing Address - Fax:503-216-1101
Practice Address - Street 1:9155 SW BARNES RD STE 634
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6632
Practice Address - Country:US
Practice Address - Phone:503-216-6662
Practice Address - Fax:503-216-1101
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC6535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-355OtherART THERAPY CREDENTIALS BOARD
ORT-10217775OtherLICENSED ART THERAPIST
ORR5811OtherPROFESSIONAL COUNSELING REGISTERED INTERN
ORC6535OtherLPC