Provider Demographics
NPI:1598202731
Name:KIP WILLIAMS PSYCHOTHERAPY (A MARRIAGE & FAMILY THERAPY CORPORATION)
Entity Type:Organization
Organization Name:KIP WILLIAMS PSYCHOTHERAPY (A MARRIAGE & FAMILY THERAPY CORPORATION)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:503-922-6339
Mailing Address - Street 1:1308 NW 20TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1607
Mailing Address - Country:US
Mailing Address - Phone:503-922-6339
Mailing Address - Fax:
Practice Address - Street 1:1308 NW 20TH AVE STE 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1607
Practice Address - Country:US
Practice Address - Phone:503-922-6339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty