Provider Demographics
NPI:1609993575
Name:CROSTHWAIT, PATRICIA ANN (LMFT, LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:CROSTHWAIT
Suffix:
Gender:F
Credentials:LMFT, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CERVANTES
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1208
Mailing Address - Country:US
Mailing Address - Phone:503-697-0515
Mailing Address - Fax:
Practice Address - Street 1:47 LADD ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3853
Practice Address - Country:US
Practice Address - Phone:503-697-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTO200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist