# KONRAD VON WALTHER LCSW LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255872032
- **Authorized official:** MR. KONRAD A VON WALTHER LCSW (OWNER)
- **Authorized official phone:** (503) 985-9640

## Contact information

- **Practice address:** 443 NE KNOTT ST, PORTLAND, OR 97212-3108
- **Practice address phone:** (971) 645-9810
- **Mailing address:** 443 NE KNOTT ST, PORTLAND, OR 97212
- **Mailing address phone:** (503) 985-9640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 16-02-15 | OR | — |
| 1041C0700X | Clinical Social Worker | 6961 | OR | Yes |

## Other

- **Enumeration date:** 03/14/2017
- **Last updated:** 03/16/2017