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Organization
IMAGINE LIFE COUNSELING AND CONSULTATION, LLC.
Active
Organization
IMAGINE LIFE COUNSELING AND CONSULTATION, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAH RENEE PARTAK LCSW, CADCII, ACS (OWNER / THERAPIST)
(503) 701-2294
Entity
Organization
Contact information
Practice address
2325 E BURNSIDE ST, SUITE 202, PORTLAND, OR 97214-1655
(503) 701-2294
Mailing address
2325 E BURNSIDE ST, SUITE 202, PORTLAND, OR 97214-1655
(503) 701-2294
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11-06-94
OR
1041C0700X
Clinical Social Worker
Primary
L4576
OR
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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