Provider Demographics
NPI:1508583626
Name:CHOW, CASEY (MA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CHOW
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S 1ST AVE
Mailing Address - Street 2:PO BOX 4041
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-272-1887
Mailing Address - Fax:
Practice Address - Street 1:7427 SW COHO CT STE 200
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8618
Practice Address - Country:US
Practice Address - Phone:503-272-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61180264101YM0800X
ORR6908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR6908OtherOREGON BOARD OF LICENSED COUNSELORS & THERAPISTS
WAMC61180264OtherWASHINGTON STATE DEPARTMENT OF HEALTH