Provider Demographics
NPI:1437607975
Name:POLMATEER, MARGIE A (LPC)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:A
Last Name:POLMATEER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARGIE
Other - Middle Name:A
Other - Last Name:LUMSDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:205 SE SPOKANE ST STE 356
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6494
Mailing Address - Country:US
Mailing Address - Phone:971-272-6225
Mailing Address - Fax:
Practice Address - Street 1:620 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7514
Practice Address - Country:US
Practice Address - Phone:971-274-3757
Practice Address - Fax:503-912-5740
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6217101YP2500X, 101YP2500X
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500731241Medicaid