Provider Demographics
NPI:1265980148
Name:SHAH, LORETTA MARIE (REGISTERED ASS MFT)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:MARIE
Last Name:SHAH
Suffix:
Gender:F
Credentials:REGISTERED ASS MFT
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8383 NE SANDY BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4986
Mailing Address - Country:US
Mailing Address - Phone:971-373-4041
Mailing Address - Fax:971-373-5285
Practice Address - Street 1:8383 NE SANDY BLVD STE 440
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4986
Practice Address - Country:US
Practice Address - Phone:971-373-4041
Practice Address - Fax:971-373-5285
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORR9483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor