Provider Demographics
NPI:1801930011
Name:DE BOER, KATRINA MARIA (LPC)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:MARIA
Last Name:DE BOER
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 1:10313 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9103
Mailing Address - Country:US
Mailing Address - Phone:503-726-3814
Mailing Address - Fax:503-726-3815
Practice Address - Street 1:494 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4141
Practice Address - Country:US
Practice Address - Phone:503-726-3814
Practice Address - Fax:503-726-3815
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-11-15101YA0400X
ORC1915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)