Provider Demographics
NPI:1336411834
Name:DAVIS, LINDA DUANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DUANE
Last Name:DAVIS
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 1:815 BERWICK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2843
Mailing Address - Country:US
Mailing Address - Phone:503-799-3276
Mailing Address - Fax:
Practice Address - Street 1:815 BERWICK CT
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2843
Practice Address - Country:US
Practice Address - Phone:503-799-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1494101YP2500X
OR63404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional