Provider Demographics
NPI:1700382801
Name:AIYANA COUNSELING LLC
Entity Type:Organization
Organization Name:AIYANA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIBLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-422-7987
Mailing Address - Street 1:PO BOX 19303
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0303
Mailing Address - Country:US
Mailing Address - Phone:503-422-7987
Mailing Address - Fax:
Practice Address - Street 1:7822 SW CAPITOL HWY STE 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2495
Practice Address - Country:US
Practice Address - Phone:503-422-7987
Practice Address - Fax:503-914-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670491Medicaid