Provider Demographics
NPI:1538286331
Name:DOCKTER, CHANTELLE K (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTELLE
Middle Name:K
Last Name:DOCKTER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-0214
Mailing Address - Country:US
Mailing Address - Phone:503-636-4176
Mailing Address - Fax:
Practice Address - Street 1:5700 SW DOSCH RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1153
Practice Address - Country:US
Practice Address - Phone:503-636-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health