Provider Demographics
NPI:1497952378
Name:KNUTSON, CAROLYN ANN (LPC, LMT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:LPC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 N COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2652
Mailing Address - Country:US
Mailing Address - Phone:503-504-0495
Mailing Address - Fax:
Practice Address - Street 1:8315 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6707
Practice Address - Country:US
Practice Address - Phone:503-504-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional