Provider Demographics
NPI:1184082505
Name:SYLVAE, JOSHUA (LMFT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SYLVAE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34378 NE RAENNA LN
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3336
Mailing Address - Country:US
Mailing Address - Phone:360-870-0928
Mailing Address - Fax:
Practice Address - Street 1:8532 N IVANHOE ST
Practice Address - Street 2:#208
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4827
Practice Address - Country:US
Practice Address - Phone:360-870-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist