Provider Demographics
NPI:1255534996
Name:RIDER, ALLISON M (MC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:RIDER
Suffix:
Gender:F
Credentials:MC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW GRIFFITH DR
Mailing Address - Street 2:SUITE 261
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-5607
Mailing Address - Country:US
Mailing Address - Phone:503-804-1285
Mailing Address - Fax:503-627-9145
Practice Address - Street 1:4900 SW GRIFFITH DR
Practice Address - Street 2:SUITE 261
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-5607
Practice Address - Country:US
Practice Address - Phone:503-804-1285
Practice Address - Fax:503-627-9145
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional