Provider Demographics
NPI:1841618253
Name:SELLWOOD COUNSELING SERVICES
Entity Type:Organization
Organization Name:SELLWOOD COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSION COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:STAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:503-851-4032
Mailing Address - Street 1:6637 SE MILWAUKIE AVE
Mailing Address - Street 2:STE. 204
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5658
Mailing Address - Country:US
Mailing Address - Phone:503-851-4032
Mailing Address - Fax:503-254-9555
Practice Address - Street 1:6637 SE MILWAUKIE AVE
Practice Address - Street 2:STE. 204
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5658
Practice Address - Country:US
Practice Address - Phone:503-851-4032
Practice Address - Fax:503-254-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3138261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)