Provider Demographics
NPI:1376981423
Name:KIM, ADAM (MS/EDS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MS/EDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 RUSHING FLUME DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6204
Mailing Address - Country:US
Mailing Address - Phone:503-806-5195
Mailing Address - Fax:
Practice Address - Street 1:3500 NE MLK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2093
Practice Address - Country:US
Practice Address - Phone:503-327-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61221488101YM0800X
NCA10098101YP2500X
ORC4888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health