Provider Demographics
NPI:1265574024
Name:KAFOURY, ANN G (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:G
Last Name:KAFOURY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 NW CULPEPPER TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3125
Mailing Address - Country:US
Mailing Address - Phone:503-227-7493
Mailing Address - Fax:
Practice Address - Street 1:804 NW CULPEPPER TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3125
Practice Address - Country:US
Practice Address - Phone:503-291-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC0731OtherL.P.C.