Provider Demographics
NPI:1376150912
Name:STRUHAR, COLLEEN LOUEDA (PCA/QMHP)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:LOUEDA
Last Name:STRUHAR
Suffix:
Gender:F
Credentials:PCA/QMHP
Other - Prefix:
Other - First Name:COLE
Other - Middle Name:LOUEDA
Other - Last Name:STRUHAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCA/QMHP
Mailing Address - Street 1:19424 SW LARKCREST LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2995
Mailing Address - Country:US
Mailing Address - Phone:503-927-2773
Mailing Address - Fax:
Practice Address - Street 1:19424 SW LARKCREST LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2995
Practice Address - Country:US
Practice Address - Phone:503-927-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7102101YM0800X, 101YM0800X
NMCMH0213081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health