Provider Demographics
NPI:1346902020
Name:AVILA ECHENIQUE, MAGDALENA
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:AVILA ECHENIQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14082 NW GARGANY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1176
Mailing Address - Country:US
Mailing Address - Phone:971-317-6416
Mailing Address - Fax:
Practice Address - Street 1:16110 SW REGATTA LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8942
Practice Address - Country:US
Practice Address - Phone:971-317-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-09
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health