Provider Demographics
NPI:1346793593
Name:KARI GJERDE LLC
Entity Type:Organization
Organization Name:KARI GJERDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:GJERDE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-388-8649
Mailing Address - Street 1:2225 NE MLK JR BLVD # 208
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3727
Mailing Address - Country:US
Mailing Address - Phone:503-388-8649
Mailing Address - Fax:
Practice Address - Street 1:2225 NE MLK JR BLVD
Practice Address - Street 2:#207
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3727
Practice Address - Country:US
Practice Address - Phone:503-388-8649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-24
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty