Provider Demographics
NPI:1619634508
Name:ARBOR COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:ARBOR COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAYSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-890-5967
Mailing Address - Street 1:2800 N LOMBARD ST # 216
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6234
Mailing Address - Country:US
Mailing Address - Phone:971-599-6431
Mailing Address - Fax:
Practice Address - Street 1:7105 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5703
Practice Address - Country:US
Practice Address - Phone:971-599-6431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1376990770Medicaid
OR1639577133Medicaid