Provider Demographics
NPI:1609442029
Name:DEBORAH MERTLICH, LCSW
Entity Type:Organization
Organization Name:DEBORAH MERTLICH, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MERTLICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-252-1545
Mailing Address - Street 1:4550 KRUSE WAY STE 340
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3586
Mailing Address - Country:US
Mailing Address - Phone:971-252-1545
Mailing Address - Fax:844-303-5253
Practice Address - Street 1:4550 KRUSE WAY STE 340
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3586
Practice Address - Country:US
Practice Address - Phone:971-252-1545
Practice Address - Fax:844-303-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL3405OtherCOMMERCIAL INSURANCE AND SELF PAY