Provider Demographics
NPI:1700534039
Name:LIKINS, DELMONT EVERGREEN (MA IN PROGRESS)
Entity Type:Individual
Prefix:
First Name:DELMONT
Middle Name:EVERGREEN
Last Name:LIKINS
Suffix:
Gender:M
Credentials:MA IN PROGRESS
Other - Prefix:
Other - First Name:DEL
Other - Middle Name:
Other - Last Name:LIKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DELTA
Mailing Address - Street 1:1235 SE DIVISION ST STE 113
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1099
Mailing Address - Country:US
Mailing Address - Phone:503-208-5284
Mailing Address - Fax:971-351-6864
Practice Address - Street 1:1235 SE DIVISION ST STE 113
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1099
Practice Address - Country:US
Practice Address - Phone:503-208-5284
Practice Address - Fax:971-351-6864
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program