Provider Demographics
NPI:1669705018
Name:NEGUS SHEMLEY, CHARLENE MICHELLE (LPC, CADC II)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MICHELLE
Last Name:NEGUS SHEMLEY
Suffix:
Gender:F
Credentials:LPC, CADC II
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:MICHELLE
Other - Last Name:NEGUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:9450 SW BARNES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6638
Mailing Address - Country:US
Mailing Address - Phone:503-216-3511
Mailing Address - Fax:503-216-5529
Practice Address - Street 1:9450 SW BARNES RD STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6638
Practice Address - Country:US
Practice Address - Phone:503-216-3511
Practice Address - Fax:503-216-5529
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-12-79U101YA0400X
ORC4025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)