Provider Demographics
NPI:1639539976
Name:CARTER COUNSELING & CONSULTING PC
Entity Type:Organization
Organization Name:CARTER COUNSELING & CONSULTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-807-7413
Mailing Address - Street 1:9600 SW OAK ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6583
Mailing Address - Country:US
Mailing Address - Phone:503-807-7413
Mailing Address - Fax:503-935-5884
Practice Address - Street 1:9600 SW OAK ST
Practice Address - Street 2:SUITE 325
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6583
Practice Address - Country:US
Practice Address - Phone:503-807-7413
Practice Address - Fax:503-935-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 1386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR188865Medicare PIN