Provider Demographics
NPI:1952794422
Name:LINGENFELTER, CARLY NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:NICOLE
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:PARNITZKE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1400 SW 5TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5537
Mailing Address - Country:US
Mailing Address - Phone:866-617-6855
Mailing Address - Fax:503-346-8015
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-494-6176
Practice Address - Fax:503-494-6152
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3324103TC0700X
PAPS018685103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist