Individual
KELLY A SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5228 NE HOYT ST, PORTLAND, OR 97213-3055
(503) 215-6474
Mailing address
PO BOX 3395, PORTLAND, OR 97208-3395
(503) 215-6474
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C3406
OR
101YP2500X
Professional Counselor
Primary
C3406
OR
Other
Enumeration date
03/09/2016
Last updated
01/03/2024
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