Provider Demographics
NPI:1265790265
Name:MEYERS, KRISTINA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 SW HUBER ST STE 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6862
Mailing Address - Country:US
Mailing Address - Phone:971-323-1121
Mailing Address - Fax:971-323-1121
Practice Address - Street 1:4711 SW HUBER ST STE 8
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6862
Practice Address - Country:US
Practice Address - Phone:971-319-4334
Practice Address - Fax:971-323-1123
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4216101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional