Provider Demographics
NPI:1669618070
Name:HENRY, MARK (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SW WASHINGTON ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2827
Mailing Address - Country:US
Mailing Address - Phone:888-628-5959
Mailing Address - Fax:503-954-3227
Practice Address - Street 1:921 SW WASHINGTON ST
Practice Address - Street 2:SUITE 460
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2827
Practice Address - Country:US
Practice Address - Phone:888-628-5959
Practice Address - Fax:503-954-3227
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC1433OtherOREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS