Provider Demographics
NPI:1669855342
Name:COLANERI, GINA (LPC, CADC-II)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:COLANERI
Suffix:
Gender:F
Credentials:LPC, CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1328
Mailing Address - Country:US
Mailing Address - Phone:503-239-8400
Mailing Address - Fax:503-239-8406
Practice Address - Street 1:10822 SE 82ND AVE
Practice Address - Street 2:SUITE K
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7658
Practice Address - Country:US
Practice Address - Phone:503-654-7444
Practice Address - Fax:503-654-0392
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health