Provider Demographics
NPI:1356239628
Name:TWO OWLS, LOKI (CADC-R CRM)
Entity type:Individual
Prefix:
First Name:LOKI
Middle Name:
Last Name:TWO OWLS
Suffix:
Gender:M
Credentials:CADC-R CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 SE 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7105
Mailing Address - Country:US
Mailing Address - Phone:503-765-0599
Mailing Address - Fax:
Practice Address - Street 1:211 NE 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2822
Practice Address - Country:US
Practice Address - Phone:971-248-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-25-5438101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)