Provider Demographics
NPI:1619624236
Name:RAINEY, GREGORY MICHALSON (LCSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHALSON
Last Name:RAINEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930 MAJESTIC CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1951
Mailing Address - Country:US
Mailing Address - Phone:503-374-4415
Mailing Address - Fax:
Practice Address - Street 1:808 SW CAMPUS DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3008
Practice Address - Country:US
Practice Address - Phone:503-494-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL108701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL10870OtherOREGON BOARD OF LICENSED SOCIAL WORKERS