Provider Demographics
NPI:1619272150
Name:NEBEN, SUSAN KROME (MA, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KROME
Last Name:NEBEN
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 SW HAMPTON ST
Mailing Address - Street 2:SUITE 331
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6950 SW HAMPTON ST
Practice Address - Street 2:SUITE 331
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8329
Practice Address - Country:US
Practice Address - Phone:503-869-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1391101YM0800X
CAMFC18419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health