Provider Demographics
NPI:1518462464
Name:WATERFIELD, KATHARYN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KATHARYN
Middle Name:
Last Name:WATERFIELD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:KAY
Other - Last Name:LOFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 SE 26TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1288
Mailing Address - Country:US
Mailing Address - Phone:503-351-2607
Mailing Address - Fax:
Practice Address - Street 1:2700 SE 26TH AVE STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1288
Practice Address - Country:US
Practice Address - Phone:503-351-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health