# IMAGINE LIFE COUNSELING AND CONSULTATION, LLC.

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

## Provider details

- **NPI number:** 1407306913
- **Authorized official:** DEAH RENEE PARTAK LCSW, CADCII, ACS (OWNER / THERAPIST)
- **Authorized official phone:** (503) 701-2294

## Contact information

- **Practice address:** 2325 E BURNSIDE ST, SUITE 202, PORTLAND, OR 97214-1655
- **Practice address phone:** (503) 701-2294
- **Mailing address:** 2325 E BURNSIDE ST, SUITE 202, PORTLAND, OR 97214-1655
- **Mailing address phone:** (503) 701-2294

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 11-06-94 | OR | — |
| 1041C0700X | Clinical Social Worker | L4576 | OR | Yes |

## Other

- **Enumeration date:** 10/07/2016
- **Last updated:** 10/07/2016