Provider Demographics
NPI:1245404466
Name:MORITZ, MYCHELLE (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:MYCHELLE
Middle Name:
Last Name:MORITZ
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SW MORRISON ST STE 305
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2628
Mailing Address - Country:US
Mailing Address - Phone:503-476-1939
Mailing Address - Fax:503-444-9561
Practice Address - Street 1:1017 SW MORRISON ST STE 305
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2628
Practice Address - Country:US
Practice Address - Phone:503-476-1939
Practice Address - Fax:503-444-9561
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional