Provider Demographics
NPI:1811553936
Name:HOAG, AMY ELISE (LPC, MCC, QMHP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELISE
Last Name:HOAG
Suffix:
Gender:F
Credentials:LPC, MCC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SW MORRISON ST STE 328
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2214
Mailing Address - Country:US
Mailing Address - Phone:971-666-3257
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST STE 328
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2214
Practice Address - Country:US
Practice Address - Phone:971-666-3257
Practice Address - Fax:541-322-7565
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health