Provider Demographics
NPI:1578757761
Name:MEREDITH, KATHLEEN MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3019
Mailing Address - Country:US
Mailing Address - Phone:503-526-3837
Mailing Address - Fax:503-526-0105
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE 501
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3019
Practice Address - Country:US
Practice Address - Phone:503-526-3837
Practice Address - Fax:503-526-0105
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0001003442OtherMHN