Provider Demographics
NPI:1922624782
Name:OTTO, MARC FRANCIS (MA, RSMT/E, LPCI)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:FRANCIS
Last Name:OTTO
Suffix:
Gender:M
Credentials:MA, RSMT/E, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3721
Mailing Address - Country:US
Mailing Address - Phone:503-309-3142
Mailing Address - Fax:
Practice Address - Street 1:215 NE 60TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3721
Practice Address - Country:US
Practice Address - Phone:503-309-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional