Provider Demographics
NPI:1659975944
Name:CLACKAMAS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:CLACKAMAS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KELSEY-FIKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-477-2428
Mailing Address - Street 1:5200 MEADOWS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-0066
Mailing Address - Country:US
Mailing Address - Phone:503-351-0463
Mailing Address - Fax:
Practice Address - Street 1:5200 MEADOWS RD STE 150
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-0066
Practice Address - Country:US
Practice Address - Phone:503-351-0463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-26
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty