Provider Demographics
NPI:1982057725
Name:BYERS, NICOLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:BYERS
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 1:1907 SE SPOKANE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6743
Mailing Address - Country:US
Mailing Address - Phone:503-880-2676
Mailing Address - Fax:
Practice Address - Street 1:1907 SE SPOKANE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6743
Practice Address - Country:US
Practice Address - Phone:503-880-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health