Provider Demographics
NPI:1437523461
Name:WALKER-HARRIS, CHANEL (LPC)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:WALKER-HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1231 NE M L KING BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2094
Mailing Address - Country:US
Mailing Address - Phone:318-518-0115
Mailing Address - Fax:
Practice Address - Street 1:2951 NW DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5292
Practice Address - Country:US
Practice Address - Phone:503-988-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5372101YP2500X
LA6515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health