Organization
CERULEAN BLUE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHARINE ELIZABETH FAZAL LMFT (OWNER)
(503) 702-0554
Entity
Organization
Contact information
Practice address
900 NW LOVEJOY ST APT 515, PORTLAND, OR 97209-3474
(503) 702-0554
Mailing address
900 NW LOVEJOY ST APT 515, PORTLAND, OR 97209-3474
(503) 702-0554
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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