Provider Demographics
NPI:1821276411
Name:FIFTH AVENUE COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:FIFTH AVENUE COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBUR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-295-7974
Mailing Address - Street 1:1312 SW 16TH AVE
Mailing Address - Street 2:#103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-2516
Mailing Address - Country:US
Mailing Address - Phone:503-295-7974
Mailing Address - Fax:503-295-3727
Practice Address - Street 1:1312 SW 16TH AVE
Practice Address - Street 2:#103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-2516
Practice Address - Country:US
Practice Address - Phone:503-295-7974
Practice Address - Fax:503-295-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0630101YP2500X
ORC2116101YP2500X
ORC1784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty