Provider Demographics
NPI:1821119967
Name:TORTORILLA, TONI (LPC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:TORTORILLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 N OBERLIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4235
Mailing Address - Country:US
Mailing Address - Phone:503-735-4745
Mailing Address - Fax:
Practice Address - Street 1:5658 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4427
Practice Address - Country:US
Practice Address - Phone:503-286-3584
Practice Address - Fax:503-285-4919
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health