Provider Demographics
NPI:1760682538
Name:TROMP, HEATHER CODY (LPC (OREGON))
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CODY
Last Name:TROMP
Suffix:
Gender:F
Credentials:LPC (OREGON)
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:CODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC (IDAHO)
Mailing Address - Street 1:3415 SE POWELL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-234-9591
Mailing Address - Fax:541-752-9270
Practice Address - Street 1:4455 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-758-5900
Practice Address - Fax:541-752-9270
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3895101Y00000X
ORC3528101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806878600Medicaid