Provider Demographics
NPI:1659473015
Name:MAKINSTER, MICHAEL GORDON (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GORDON
Last Name:MAKINSTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 NE HASSALO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5439
Mailing Address - Country:US
Mailing Address - Phone:503-636-4176
Mailing Address - Fax:
Practice Address - Street 1:8815 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5861
Practice Address - Country:US
Practice Address - Phone:971-409-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional