Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 19-QMHPC-00301 | OR |
N | 104100000X | Social Worker | A4003 | OR |
NPI | 1003213737 |
---|---|
Provider Name | Kathy A Litvin |
First Address | Portland, OR 97205-1715 |
Second Address | Gresham, OR 97030-7514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2014 |
Last Update Date | 02/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500680935 | (05) | OR |