Provider Demographics
NPI:1659662765
Name:BALDWIN, JAMES FOWLER (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FOWLER
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2188 SW PARK PL STE 303
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1100
Mailing Address - Country:US
Mailing Address - Phone:503-241-1141
Mailing Address - Fax:503-954-2224
Practice Address - Street 1:2188 SW PARK PL STE 303
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1100
Practice Address - Country:US
Practice Address - Phone:503-241-1141
Practice Address - Fax:503-954-2224
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2206101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor