Provider Demographics
NPI:1821617267
Name:AUERBACH, JOHN S (LCP-INTERN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:AUERBACH
Suffix:
Gender:M
Credentials:LCP-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1898
Mailing Address - Country:US
Mailing Address - Phone:503-622-8964
Mailing Address - Fax:503-715-5469
Practice Address - Street 1:1785 NE SANDY BLVD STE 270
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2791
Practice Address - Country:US
Practice Address - Phone:503-622-8964
Practice Address - Fax:503-715-5469
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor