Provider Demographics
NPI:1932188547
Name:RAHE, CHARLES EVAN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EVAN
Last Name:RAHE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51579 COLUMBIA RIVER HWY
Mailing Address - Street 2:STE 'I'
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-8411
Mailing Address - Country:US
Mailing Address - Phone:503-543-6164
Mailing Address - Fax:503-543-6040
Practice Address - Street 1:51579 COLUMBIA RIVER HWY
Practice Address - Street 2:STE 'I'
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-8411
Practice Address - Country:US
Practice Address - Phone:503-543-6164
Practice Address - Fax:503-543-6040
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL13301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROR03358OtherPACIFICARE
93119252597203 A004OtherTRICARE
OR00WFBRYBMedicare ID - Type Unspecified