Provider Demographics
NPI:1801952908
Name:GRUMM, MAILE LOUISE (LPC)
Entity type:Individual
Prefix:MS
First Name:MAILE
Middle Name:LOUISE
Last Name:GRUMM
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 1:1925 SE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3209
Mailing Address - Country:US
Mailing Address - Phone:503-218-3709
Mailing Address - Fax:503-710-9072
Practice Address - Street 1:1925 SE 47TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3209
Practice Address - Country:US
Practice Address - Phone:503-218-3709
Practice Address - Fax:503-710-9072
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional