Provider Demographics
NPI:1417301193
Name:LISA BITIKOFER, LCSW, LLC
Entity Type:Organization
Organization Name:LISA BITIKOFER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BITIKOFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-910-4011
Mailing Address - Street 1:145 WILSON ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4232
Mailing Address - Country:US
Mailing Address - Phone:503-910-4011
Mailing Address - Fax:503-588-8467
Practice Address - Street 1:145 WILSON ST S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4232
Practice Address - Country:US
Practice Address - Phone:503-910-4011
Practice Address - Fax:503-588-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3363251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health