Provider Demographics
NPI:1437554581
Name:CADY RUSSELL, MICHAEL LAWRENCE (MS, NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:CADY RUSSELL
Suffix:
Gender:M
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 SE SALMON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4136
Mailing Address - Country:US
Mailing Address - Phone:503-679-3798
Mailing Address - Fax:503-914-1791
Practice Address - Street 1:1942 NW KEARNEY ST
Practice Address - Street 2:SUITE 32
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1426
Practice Address - Country:US
Practice Address - Phone:503-683-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR2739101YP2500X
OR143715101YS0200X
ORC4675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool