Provider Demographics
NPI:1659684561
Name:SHORE, HOWARD EVERETT (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:EVERETT
Last Name:SHORE
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29091
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296-9091
Mailing Address - Country:US
Mailing Address - Phone:503-367-5786
Mailing Address - Fax:
Practice Address - Street 1:4031 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5243
Practice Address - Country:US
Practice Address - Phone:503-367-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health