Provider Demographics
NPI:1184781726
Name:PISTER, KARL P (LCSW)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:P
Last Name:PISTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 SW BARBUR BLVD
Mailing Address - Street 2:SUITE 300BL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5908
Mailing Address - Country:US
Mailing Address - Phone:503-796-9694
Mailing Address - Fax:503-981-8584
Practice Address - Street 1:10175 SW BARBUR BLVD
Practice Address - Street 2:SUITE 300BL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5908
Practice Address - Country:US
Practice Address - Phone:503-796-9694
Practice Address - Fax:503-981-8584
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical