Provider Demographics
NPI:1841576550
Name:NIELSEN, ENID E (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ENID
Middle Name:E
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 SW PACIFIC HWY
Mailing Address - Street 2:SUITE 100-5
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8649
Mailing Address - Country:US
Mailing Address - Phone:503-706-4320
Mailing Address - Fax:
Practice Address - Street 1:11501 SW PACIFIC HWY
Practice Address - Street 2:SUITE 100-5
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8649
Practice Address - Country:US
Practice Address - Phone:503-706-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2693101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional